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Thomas, Milinda Sue A / ,7 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Milinda Sue Thomas Female Date of Death Age If Veteran of U.S.Armed Forces, 12/07/2021 35 Years War or Dates i... Place of Death Hospital,Institution or WCity,Town or Village Moreau Town Street Address 10 B Pine Hill Drive, Moreau Town,New York 12803 Manner of Death © Natural Cause ❑Accident Homicide El Suicide ❑Undetermined Pending (Wj Circumstances Investigation 0 Medical Certifier Name Title David DeCelle Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 60 ❑Burial Date Cemetery,Crematory or Facility Name 12/10/2021 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York ElDonation O Removal Date Place Removed H and/or and/or Held N Hold Address 0 d. Date Point of Cl) Li Transportation p 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-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom E. Remains are Shipped,If Other than Above 2M Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/10/2021 Registrar of Vital Statistics Geeann Mc ca6e(ECectronica1Ty Signed) (signature) District Number 4562 Place Moreau, 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//2s'. / Place of Disposition tJe J f pw °rev&g 410 t- (address) W CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of emises Ifinpd Z (please print) W Signature Title 6-6263A-471— DOH-1555(07/18)p 1 of 2 li. 543C 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#