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Brown, Elaine Muriel NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elaine Muriel Brown Female Date of Death Age If Veteran of U.S.Armed Forces, 12/17/2021 94 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc p Manner of Death ©Natural Cause ❑Accident 0 Homicide El Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title ID Philip Gara MD Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 71 ❑Burial Date Cemetery,Crematory or Facility Name 12/20/2021 Pine View Crematory Entombment Address ElCremation Queensbury Town,New York ▪Donation ZO Removal Date Place Removed and/or and/or Held F Hold Address CO 0 d Date Point of Cl) ❑Transportation Shipment Q by Common Carrier Destination Date Cemetery Address LiDisinterment 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 Il— Remains are Shipped,If Other than Above 2 Address C W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/20/2021 Registrar of Vital Statistics Aimee G Mahoney(ECectronicatTy Signed) (signature) District Number 5755 Place Fort Edward, 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 /,?2/-2dg/ Place of Disposition �.��° U'1�►� £ rem)4. - 2 (address) W CC (section) (lot number) (grave number) CC ,a 0 Name of Sexton or Person in Charge of Premises / K Ar�Yfl7''r b Z ase p nt) W Signature :-f1 ���l Title Oe<J"1 DOH-1555(07/18)p 1 of 2 01 c46 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#