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Pratt, John Edwin NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Edwin Pratt Male Date of Death Age If Veteran of U.S.Armed Forces, 11/12/2021 87 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Valatie Village Street Address Bamwell Nursing And Rehabilitation Center W Manner of Death © ❑Undetermined ❑Pending � Natural Cause Accident Homicide Suicide W Circumstances Investigation W Medical Certifier Name Title Kathleen Steiger NP Address ' 3230 Church St,Valatie Village,New York 12184 Death Certificate Filed District Number Register Number City,Town or Village Valatie Village 1023 66 ❑Burial Date Cemetery,Crematory or Facility Name 11/15/2021 Pine View Crematory Entombment Address ]Cremation Queensbury Town,New York Donation Ei 0 Removal Date Place Removed and/or and/or Held f- Hold Address 0 d Date Point of Cl) ❑Transportation by Common Shipment Carrier Destination El Disinterment Date Cemetery Address 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 5 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/15/2021 Registrar of Vital Statistics Barbara Ann Fischer(Electronically Signed) (signature) District Number 1023 Place Valatie Village, 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 II IS h4 Place of Disposition (address W O /fri /section/ � lloumb� /grave number/ ID Name of Sexton or Person i rge of PremisesJllv� wY�L ease print)/yam W n. Signature Title [ �" DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) 1 Receipt 1 i Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#