Brooks, Joanne Marie NEWYORKSTATEDEPARTMENTOFHEALTH BUrIal - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Joanne Marie Brooks Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/05/2022 63 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Whitehall Village Street Address 8 Elizabeth Street 217,Whitehall Village,New York 12889
p Manner of Death jj Natural Cause Accident Ei Homicide ESuicide FlUndetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
G Charles Yun MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Village Of Whitehall District Number Register Number
City,Town or Village 5728 9
Burial Date Cemetery,Crematory or Facility Name
05/10/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
❑Donation
g El Date Place Removed
Removal and/or Held
— and/or
CA Hold Address
dDate Point of
(A Transportation Shipment
Q by Common
Carrier Destination
D
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
H Remains are Shipped,If Other than Above
"' Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/10/2022 Registrar of Vital Statistics Patti Gordon(ECectronica1TySigned)
(signature)
District Number 5728 Place Village Of Whitehall
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W~ ✓I�
Date of Disposition VI I In. Place of Disposition /address/
W
(section) /1 (IS-number) &mit ti (grave number)
gofSexton or l�
Name Person in Charge of Premises ^'
Z (pile print) �,,,_�
W Signature Ems' Title L i,47'M4 `i
DOH-1555(07/18)p t of 2
m4 S
Public Health Law Sec. 4145(2b)
1
yReceipt
1
1
{ Human remains of delivered on , 20
1
1
1
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#