Bills, Karen Sue ELF
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Karen Sue Bills Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/12/2022 61 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
WManner of Death Ill Natural Cause Accident Homicide []Suicide []Undetermined []Pending
U I 1Circumstances I 'Investigation
Medical Certifier Name Title
Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 213
[]Burial Date Cemetery,Crematory or Facility Name
04/15/2022 Pine View Crematory
Address
IIICremation Queensbury Town,New York
Donation
OZElRemoval Date Place Removed
and/or and/or Held
f- Hold Address
0
d Date Point of
U) Transportation
Q 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-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
5 Address
C
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/14/2022 Registrar of Vital Statistics Megan Wolin(ECectronicaCCySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition II54 U. Place of Disposition � „ 4r-.._
2 (address)
W
Cl)CC (section) f (lot number) (grave number)
NN
0 Name of Sexton or Person in Charge of Premis ► 4 1�
Z (ple&e print)
I1J Signature Title �� �
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
I
1
, Receipt
Human remains of delivered on , 20 -.
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#