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Hermandez, Elizabeth Ann / s NEW YORK STATE DEPARTMENTOF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elizabeth Ann Hernandez Female Date of Death Age If Veteran of U.S.Armed Forces, 02/09/2022 64 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 59 Aviation Road,Queensbury Town, New York 12804 Manner of Death ©Natural Cause 0 Accident Homicide Suicide El Undetermined Pending VCircumstances Investigation WQ Medical Certifier Name Title Charles Yun MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 35 ElBurial Date Cemetery,Crematory or Facility Name 02/11/2022 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ElDonation ElRemoval Date Place Removed and/or and/or Held N Hold Address 0 4. Date Point of N ❑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 H Remains are Shipped,If Other than Above 2 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2022 Registrar of Vital Statistics Caroline 7fi&t1egarrfe Barber(ECectronicaCCy Signed) (signature) District Number 5657 Place Queensbury, 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 'llP�-}\ Place of Disposition y,� Yl pi kl � 000 2 (address) W Cl) CC (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premises i4'tr- y cS`v+r Z (please print) W Signature L� ,/ Title Cirityv1Q4.r r DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) � n Receipt IHuman remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#