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Day, Albert Charles a 7 * NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Albert Charles Day Male Date of Death Age If Veteran of U.S.Armed Forces, 11/17/2021 59 Years War or Dates F- Place of Death Hospital,Institution or WCity,Town or Village Warrensburg Town Street Address 2324 Schroon River Road,Warrensburg Town,New York 12885 p Manner of Death ❑ Natural Cause ❑Accident ❑Homicide ©Suicide ❑Undetermined 0 Pending W Circumstances Investigation W Medical Certifier Name Title G Lynn Keil PA Address 1340 State Rt 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 28 ❑Burial Date Cemetery,Crematory or Facility Name 11/19/2021 Pine View Crematory ❑Entombment Address LICremation Queensbury Town,New York ❑Donation Z CI Removal Date Place Removed and/or and/or Held H Hold Address N 0 a Date Point of Cl) ❑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 E— Remains are Shipped,If Other than Above 5 Address OC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/19/2021 Registrar of Vital Statistics (Pamela M Lloyd(E(ectronica((ySigned) (signature) District Number 5660 Place Warrensburg, 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 ike 7,z, Place of Disposition r r (J e Ilia/ CN 4 r W 2 (address) W CC N (section) (lot num er) (grave number) J 0 Name of Sexton or Person in Charge Premises Ta� Q/' fXd� _ , W // (please print) Signature I Title te r DOH-1555(07/18)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#