Braman, Gladys Estelle • ,.
4E) t-I
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gladys Estelle Braman Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/17/2022 94 Years War or Dates
E.. Place of Death Hospital,Institution or
WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
p Manner of Death ❑x Natural Cause Accident Homicide Duicide FlUndetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
O Carrie Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 42
Burial Date Cemetery,Crematory or Facility Name
05/18/2022 Pine View Crematory
Entombment Address
IliCremation Queensbury Town,New York
DDonation
0❑Removal Date Place Removed
- and/or and/or Held
- Hold Address
N
0
O. Date Point of
U)❑Transportation Shipment
p by Common
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
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/18/2022 Registrar of Vital Statistics Aimee L Mahoney(Electronically Signed)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 5-Ill+7 Place of Disposition
W (address)
W
N (section) (1w number) (grave number)
(i 1 v 4 61
0 Name of Sexton or Person in Charge of Premises (pie eprint)
W Signature Title
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#