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Latterell, Sylvia Mae
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sylvia Mae Latterell Female Date of Death Age If Veteran of U.S.Armed Forces, 10/23/2021 85 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc Manner of Death Undetermined Pending W © Natural Cause Accident Homicide ❑SuicideLi O Circumstances Investigation W Medical Certifier Name Title Carrie Miron PA Address 319 Broadway, Fort Edward Town, New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 62 ❑Burial Date Cemetery,Crematory or Facility Name 10/25/2021 Pine View Crematory El Entombment A4tlress ElCremation aueensbury Town,New York ElDonation • ElRemoval Date Place Removed and/or and/or Held to Hold Address 0 n- Date Point of Cl) LiTransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address El Reinterment Date Cemetery Address `" Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above a Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/25/2021 Registrar of Vital Statistics Aimee G Mahoney(ECectronica1ty Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition to I 7I9 111 Place of Disposition t � 74.4or�. 2 (address) W Wre (section) lot number) (grave number) G Name of Sexton or Person in Charge of Premises A t `� (Please riot/ W Signature /‹. Title W4IvC DOH-1555(07/18)p 1 of 2 949 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on 20 • Pine View Cemetery Representing the funeral home named o bulrial.peeppit Official Funeral Directors Reg.or License# , r f