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McElrath, Michelle Marie 411013 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Michelle Marie McElrath Female Date of Death Age If Veteran of U.S.Armed Forces, 12/03/2021 67 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide LiUndetermined Pending Circumstances Investigation U Wp Medical Certifier Name Title Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 573 0 Burial Date Cemetery,Crematory or Facility Name 12/06/2021 Pine View Crematory 0 Entombment Address lCremation Queensbury Town,New York ❑Donation OZ Removal Date Place Removed and/or and/or Held Hold Address N O a 1-1 Date Point of (/) ❑Transportation p by Common Shipment Carrier Destination 0 Disinterment Date Cemetery Address EReinterment 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 Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/06/2021 Registrar of Vital Statistics Wp6ertAnrdrew Curtis(ElectronicaCtySigned) (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: l- Date of Disposition 1�—��-fit Place of Disposition F/V1tJ1%,1.14/ ( fe_,,,v4 �r (address) W CC CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises J LE y (IA),rc,5 Z (please print) W Signature `, Title L('c.wK-frir DOH-1555(o7/18)p 1 of 2 '71, 15 4:I1 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on t , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#