Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Mitchell, Jim Martin
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jim Martin Mitchell Male Date of Death Age If Veteran of U.S.Armed Forces, 12/10/2021 92 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Manner of Death © Natural Cause Accident Homicide Suicide ❑Undetermined Pending W V Circumstances Investigation W Medical Certifier Name Title C1 Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 586 ©Burial Date Cemetery,Crematory or Facility Name 12/15/2021 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held ~ Hold Address 0 d Date Point of (1) LiTransportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 E.. Remains are Shipped,If Other than Above a Address CC ILL! 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/10/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ~ �) Ouct-KeR R� LJ n 7 N/12604 N (address) W Date of Disposition l�•1� 'd� Place of Disposition �I�ex�e O (sectja/ (lot number) (grave number) O Name of Sexton r Person in Char e of Premises �t�r7 i C (please print) W Signature Title CL_-r , n ICJ i DOH-1555(o7/t8)p tar 2 Mitchell NAME Jim Martin Mitchell Age: 92 Lot Owner: Martha Mitchell Lot# New Kenesaw 30A Grave# 1 Case: Concrete Died: 1 2 . 1 0.21 Interred: 1 2. 1 5.21 Funeral Home: M•B.Kilmer Cemetery: Pine View • t •t+C-41t,a(-' .on Lot Na.30A Owner John g. Dorlon >-Y c i ('�caQ �a 1Y�;}�,lne.lt Section ..No:' Address 9 Cunningham Ave. ,Ulens r'alls, N.Y. Plot New Kenesaw Date 6/39/59 Approx.100 Superficial ft. @ i.30 per sq. ft.-g130.00 Location Bounded on s/e by Dorlon lot; on s/w by grass path Corner Posts Remarks Deed No. (and changes) 748 Payment Record Paid in full 6/30/59 Form No. 01 } Record of Intermerits bc,6 id- ra&I 1 I nmcs c -.-c ,11 1ca?- 15.S i 5 2I I6I 3I 7I 4 I I 8 44>(t%1 • CO ' Y 3 0 R h S s r"A T - rr • 4 if/Ott/fl o/ Queetattry QUEENSBURY TOWN OFFICE BUILDING BAY AND HAVILAND ROADS. R. D. 1 GLENS FALLS, NEW YORK, 12801 TELEPHONE: (518) 792-5892 HIGHWAY DEPT. 793-7771 SEPTEMBER 28 , 1983 MR. JOHN H. DORLON JR. 9531 BURWICK SAN ANTONIO , TEXAS 78230 DEAR MR. DORLON : IN REGARD TO YOUR LETTER DATED SEPTEMBER 215T11983 I WILL ACCEPT THIS AS CONFORMATION TO CONVEY THE LOTS IN PINE VIEW INTO YOUR SISTER'S NAME ( MARTHA DORLON MITCHELL) . IF YOU HAVE ANY FURTHER QUESTIONS PLEASE FEEL FREE TO CALL ON THIS OFFICE . RESPECTFULLY , q7e, ODNEY 15. MOSHER PINE VIEW SUPERINTENDEF