Towers, Sandra Doris 3i9
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NEW VORKSTATE DEPARTMENT OF HEALTH 1:111Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sandra Doris Towers Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/10/2022 76 Years War or Dates
E.. Place of Death Hospital,Institution or
Z City,Town or Village Valatie Village Street Address Bamwell Nursing And Rehabilitation Center
U l
Manner of Death 1=1Natural Cause Accident IIIHomicide Suicide ❑Undetermined Pending
✓ Circumstances Investigation
ILI a Medical Certifier Name Title
Kathleen Steiger NP
Address
3230 Church St,Valatie Village,New York 12184
DeaRth Certificate Filed Village Of Valatie District Number Register Number
City,Town or Village 1023 23
Burial Date Cemetery,Crematory or Facility Name
04/13/2022 Pine View Crematory
Entombment Address
EICremation Queensbury Town,New York
❑Donation
Q❑Removal Date Place Removed
and/or and/or Held
Hold Address
10
IL Date Point of
(A❑Transportation
Q by Common Shipment
Carrier Destination
E
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
Remains are Shipped,If Other than Above
'- Address
Q
ILl
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/13/2022 Registrar of Vital Statistics Barbara Ann Tischer(ECectronicallySigned)
(signature)
District Number 1023 Place Village Of Valatie
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH
W Date of Disposition y49^Z.02Z Place of Disposition ?fYt ear et,, () -f b 7
2 (address,
W
It (section) /(lot number) (grave number)
D Name of Sexton or Pers in Cha a of Premises 3 t''- �t CL (�i of �e
Z (please print)
W. Signature : __ Title Z 4�m Adler 4y4�
DOH-1555(o7/18) 1 of 2
Public Health Law Sec. 4145(2b) 5 S
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#