Cross, Betty J # 3,,.
CILF, '
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Betty J.Cross Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/27/2022 75 Years War or Dates
H Place of Death Hospital,Institution or
L2 City,Town or Village Glens Falls Street Address Glens Falls Hospital
CI W Manner of Death El Natural Cause nAccident n Homicide Suicide Undetermined Pending
Circumstances I IInvestigation
I Medical Certifier Name Title
a Kasandra Frasier PA
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 231
Burial Date Cemetery,Crematory or Facility Name
04/28/2022 Pine View Crematory
Entombment Address
ZCremation Queensbury Town,New York
Donation
2❑Removal Date Place Removed
and/or and/or Held
F. Hold Address
N
0
a Date Point of
CO ElTransportation
`p by Common Shipment
Carrier Destination
O
Disinterment
Date Cemetery Address
n 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
,'" Address
CC
W
Et Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/27/2022 Registrar of Vital Statistics Megan Norm(ECectronica1CySigned)
(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:
I--
Z Date of Disposition y?p—Zi 7, Place of Disposition 'A E tA'e ) Ci,
2 (addres
C (section) / (of-n7ummber) (grave number)
0 Name of Sexton or Person in Charg f Pre ises /g7<'j10� CZ`e J
Z (please print)
Ui Signature Title vrC
DOH-1555(07/18)p 1 of 2
•
Public 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#