Noyes, John Robert el) # 71
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John Robert Noyes Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/31/2022 87 Years War or Dates
E.. Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 44 Willowbrook Road A309,Queensbury Town,New York 12804
Q Manner of Death El Natural Cause Accident El Homicide EllSuicide ❑Undetermined ❑Pending
W
0 Circumstances Investigation
GMedical Certifier Name Title
Christopher Hoy MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 63
Burial Date Cemetery,Crematory or Facility Name
.m" 04/04/2022 Pine View Crematory
Entombment Address —
EICremation Queensbury Town,New York
Donation
g❑Removal Date Place Removed
H and/or and/or Held
- Hold Address
0
O. Date Point of
Cl)❑Transportation
C 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
1.. Remains are Shipped,If Other than Above
2 Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/02/2022 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed)
(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:
Z / ( ` '
W Date of Disposition ('I 5 f it Place of Disposition X I�V� r��
2 (address)
W
N
CC (section)
(lot number) (grave number)
Name of Sexton or Person in Charge of Premises I tti �Gst�itt
z /pleasdjorint/
W Signature ".(1 4. Title (06
111 Y4 Z
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
I
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#