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Bilven, Jeanne Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Jeanne Elizabeth Bliven Female Date of Death Age If Veteran of U.S.Armed Forces, 01/18/2022 96 Years War or Dates Place of Death Hospital,Institution or ZCity,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined El Pending W Circumstances Investigation 0 W Medical Certifier Name Title 0 Brandii Baker NP Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 3 ▪Burial Date Cemetery,Crematory or Facility Name 01/19/2022 Pine View Crematory ❑Entombment Address O Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed oand/or and/or Held H Hold Address N 0 ib Date Point of f/) Li Transportation by Common Shipment Carrier Destination Date Cemetery Address El Disinterment 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 1— Remains are Shipped,If Other than Above Address CC ILLI O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/19/2022 Registrar of Vital Statistics Shelley 9Kckernon(ECectronicaffySigned) (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: Z Date of Disposition I I i't I iZ Place of Disposition •Rae ,_ n +0._... W (address) W CCCC (section) (lot number) (grave number) G Name of Sexton or Person in Charge o Premises f,` � s.�°� Z (plea print) / W Signature y Title C "AOrt_ DOH-1555(07/18)p 1 of 2 a - V 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# -