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Bowen, Joan W f5g 2 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joan W Bowen Female Date of Death Age if Veteran of U.S.Armed Forces. 11/17/2021 91 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village South Glens Falls Village Street Address 33 William Street,South Glens Falls Village.New York 12803 Manner of Death ®Natural Cause 1:3Accident 0 Homicide 0 Suicide Undetermined El Pending UCircumstances Investigation 8 Medical Certifier Name Title Thomas Kandora MD Address • 100 Park St.Glens Fails,New York 12801 Death Certificate Filed District Number Register Number City.Town or Village South Glens Falls Village 4524 23 Burial Date Cemetery,Crematory or Facility Name 11/19/2021 Pine View Crematory Entombment Address ©Cremation oueensbury,New York Donation 0 Removal Date Place Removed and/or and/or Held N Hold Address Date Point of (/) 0 Transportation p by Common Shipment Carrier Destination EIDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Fells 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 Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued t 1/19/2021 Registrar of Vital Statistics joy rBartlto(omew((LectronicafySigned) (signature) District Number 4524 Place South Glens Falls Village. New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition II I Pi I Z, Place of Disposition 04 air-•_. 2 (address) W N CC /section) /1(4, llol number) (grave number) y.g Name of Sexton or Person in Charge of Premises 1—� 5/h•+�� Z Tease print) W Signature l� Title Iil"Ol DOH-1555(07/18)p t of 2 TO 3OVd i'i3W1I>IEW BLSLLVLO TS LS:TZ IZ0Z/8I/I t b. Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 ry' Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#