Richmond, George Farnum ...-LC:F) A 531
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
George Farnum Richmond Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/16/2022 99 Years War or Dates WWII
H Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 71 Longview Drive 165,Queensbury Town,New York 12804
LLI
,Q Manner of Death Natural Cause ❑Accident I I I I Homicide S❑ uicide ❑Undetermined ❑Pending
W x .
Circumstances Investigation
W Medical Certifier Name Title
G Melanie Duerr NP
Address
47 Tom Phelps Lane,Mineville Hamlet,New York 12996
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 75
®Burial Date Cemetery,Crematory or Facility Name
04/19/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
o❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
(/)OTransportation
CI by Common Shipment
Carrier Destination
o
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
a Address
CC
IL
O' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/18/2022 Registrar of Vital Statistics Caroline xlfegarcle Bar6er(ECectronicallySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— � '
Z Date of Disposition Li171 I It Place of Disposition "1 ►„►�1.L� ft----
W
2 (address)
W
CO
CC (section) slot numbers/ � µ (grave number)
G Name of Sexton or Person in Charge of Premises L/,l'�t`� l►• ^t�1
/pleaserint/
Z
W Signature Title r i
DOH-1555(07/18)p 1 of 2
`15(38 7Public 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#