Savoie, Pierre Joseph CLF 4307
•
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Pierre Joseph Savoie Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/07/2022 73 Years War or Dates
F,, Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
O Manner of Death El Natural Cause []Accident ri Homicide [IISuicide Undetermined ❑Pending
Circumstances Investigation
Lii Medical Certifier Name Title
William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
DeaRth Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 201
Burial Date Cemetery,Crematory or Facility Name
04/08/2022 Pine View Crematory
Entombment Address —
ZCremation Queensbury Town,New York
Donation
Z Date Place Removed
Q❑Removal
and/or and/or Held
N Hold Address
0
a Date Point of
t/)0Transportation
ES Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
[]Reinterment
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
1 Remains are Shipped,If Other than Above
g Address
CC
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Q Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/08/2022 Registrar of Vital Statistics Megan Wolin(ECectronicalTySigned)
(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 y N+ZZ Place of Disposition 47AL 4)----...
W
2' (address)
W
CO
IX (section) (lot number) (grave number)
GName of Sexton or Person in Char f Premises 4 fr
Z (plyase print) /�,�.� '�/
W Signature ,./ — Title i �✓"'"' W�
DOH-1555(07/18)p 1 of 2
U5955
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ,,t`-'' \,, delivered on , 20` �_
Pine View Cemetery Representing the funeral home named on pu al ermit
Official Funeral Directors Reg.or License# j t