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Stevens Helen Etta rr NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Helen Etta Stevens Female Date of Death Age If Veteran of U.S.Armed Forces, 11/27/2021 91 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare • Manner of Death © Undetermined Pending Natural Cause Accident Homicide Suicide W Circumstances Investigation W Medical Certifier Name Title G Joshua Started NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 72 ❑Burial Date Cemetery,Crematory or Facility Name 11/29/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation • Removal Date Place Removed and/or and/or Held N Hold Address 0 0- Date Point of U) ❑Transportation O 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-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above ▪ Address fr a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/29/2021 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 Date of Disposition a--0?'zr�Z( Place of Disposition �I e Oet-ci ertij11 ti 2 (ad LLI (section) (lot n tuber) (grave number) O Name of Sexton or Person in Charge of Premises �' AC/ ar� Ilex) z f (please print) Title W Signature �j�PJ 0L�� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 Receipt 1 I Human remains of delivered on , 20` Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#