McCotter, Gladys Marie g /002
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gladys Marie McCotter Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/23/2021 67 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death Natural Cause El Accident Homicide Suicide Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
C3 Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 539
Burial Date Cemetery,Crematory or Facility Name
11/26/2021 Pine View Crematory
Entombment Address
lCremation Queensbury Town,New York
Donation
Removal Date Place Removed
- El
and/or and/or Held
t`N Hold Address
0
d 1-1 Date Point of
CO Li Transportation Shipment
p by Common
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
a Address
Er
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/26/2021 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:
2 C �+
W Date of Disposition �/a��Ozl Place of Disposition Pi�� ('� °LJ
2 (addr
W
CC
N (section) I (lot nu er) (grave number)
0 Name of Sexton or Person in Charge remise /1����
z (please print)
W Signature Title
DOH-1555(07/18)p 1 of 2
.,f 1. R
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#