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Maille, Edward Leo NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edward Leo Maille Male Date of Death Age If Veteran of U.S.Armed Forces, 11/28/2021 89 Years War or Dates 1951-1953 Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing `p Manner of Death ©Natural Cause p Accident El Homicide ❑Suicide Undetermined ❑Pending Circumstances Investigation W▪ Medical Certifier Name Title 0 Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 226 ❑Burial Date Cemetery,Crematory or Facility Name 11/30/2021 Pine View Crematory 0 Entombment Address X❑Cremation Queensbury Town,New York 0 Donation OZ Removal Date Place Removed and/or and/or Held N Hold Address O a Date Point of (A ❑Transportation Q 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-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above ff Address IW Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/30/2021 Registrar of Vital Statistics Caroline JfiCtfegarie Barber(ECectronically Signed) (signature) District Number 5657 Place Queensbury, 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 /a-3-2.OZl Place of Disposition f( .1C (address) W f (section) ((lot num'be�r) (grave number) G Name of Sexton or Person in Charge o emise > j�1l�rv� O� Z' /please print) IU Signature T Title (ee.5-44° DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) Receipt 1 IHuman remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial,permit Official Funeral Directors Reg.or License#