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Palmer, Adelaide gS3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Adelaide Palmer Female Date of Death Age If Veteran of U.S.Armed Forces, 10/22/2021 79 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Wallkill Town Street Address Garnet Health Medical Center W Manner of Death G © Natural Cause �Accident El Homicide El Suicide El Undetermined �Pending W Circumstances Investigation W Medical Certifier Name Title O Gena Brower PA Address 707 E Main St,Wallkill Town,New York 10940 Death Certificate Filed District Number Register Number City,Town or Village Wallkill Town 3566 730 ElBurial Date Cemetery,Crematory or Facility Name 10/25/2021 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held __._ Hold Address CO 0 0. Date Point of coLi Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number _Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped,If Other than Above 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/24/2021 Registrar of Vital Statistics Louisa Majeffa Ingrassia(ECectronica/Ty Signed) (signature) District Number 3566 Place Wallkill Town, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z , W Date of Disposition (O1Zs1'Lj Place of Disposition -[ In,�.�l�. 2 (address) W (section) 4 (lot number) (grave number) c, Name of Sexton or Person in Charge of P ises lease print) AVAN�/�( W Title I�� Signature DOH-1555(07/18)p 1 of 2 I '-r,:I 5;-,25C Public Health Law Sec. 4145(2b) Receipt ' .. , ., ,I A •/1 r , .'1 . , fr, , 1 } , Human remains of \ t ,,, '.- ,s, *i ,, t , delivered on , 20 ' , 4 i Pine View Cemetery Representing the funeral home named rri buri4l6permit Official Funeral Directors Reg. or License# '; '........' I 1