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Irwin, Claudia DAle
NEW YORKSTATE DEPARTMENT OF HEALTH • Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Claudia Dale Irwin Female Date of Death Age If Veteran of U.S.Armed Forces, 11/18/2021 71 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Hartford Town Street Address 59 Russell Lane, Hartford Town,New York 12809 p• Manner of Death ©Natural Cause ❑Accident El HomicideSuicide El Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title C Aqeel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Hartford 5759 7 ▪Burial Date Cemetery,Crematory or Facility Name 11/22/2021 Pine View Crematory ❑Entombment Address O Cremation Queensbury Town,New York Donation O Removal Date Place Removed and/or and/or Held H Hold Address 0 Date Point of (I) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom 1.. Remains are Shipped,If Other than Above • Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/20/2021 Registrar of Vital Statistics Denise(Petteys(E(ectronica1TySigned) (signature) District Number 5759 Place Hartford, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition I/1 Z3 11,1 Place of Disposition i address W CC N (section) ,(lot number) (grave number) O Name of Sexton or Person in Charge of Pre s 71; L ti{tr Z (pleaa print) tJV Signature "" Title ( Oa DOH-1555(o7/t8)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 • Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#