Starling, John Michael NEW YORK STATE DEPARTMENT OF HEALTH ' —Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
John Michael Starling Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/04/2021 77 Years War or Dates 1965-1967
I}- Place of Death Hospital,Institution or
Z City,Town or Village Hudson Falls Village Street Address 3 4th Street, Hudson Falls Village, New York 12839
Ill
p Manner of Death IXI Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
UCircumstances Investigation
MI 0 Medical Certifier Name Title
Courtney Bowers NP
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Hudson Falls Village 5726 32
❑Burial Date Cemetery,Crematory or Facility Name
11/08/2021 Pine View Crematory
El Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
❑Removal Date Place Removed
and/or •
and/or Held
1—N Hold Address
0
a- Date Point of
(n ❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/05/2021 Registrar of Vital Statistics Cynthia ABarc[in(ECectronicaCCySigned)
(signature)
District Number 5726 Place Hudson Falls Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-- /
W Date of Disposition 11 /}�'"L1 Place of Disposition f�j
(address)
W
U) (section) (lot number) (grave number)
� c
0 Name of Sexton or Person in Charge of P emises ��� cJ fMwL�f
Z lease print/
W Signature Title (vz Uo �'
DOH-1555(07/18)p 1 of 2
1 i53iC
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#