Latterell, Janet May NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Janet May Latterell Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/02/2022 80 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
MannerW ofDeath El Natural Cause ri Accident El Homicide nSuicide Undetermined ❑Pending
Circumstances Investigation
QMedical Certifier Name Title
Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 301
Burial Date Cemetery,Crematory or Facility Name
06/04/2022 Pine View Crematory
IllEntombment --
Address
Cremation Queensbury Town,New York
Donation
,'� Date Place Removed
Removal and/or Held
and/or
Hold Address
0
0- Date Point of
N Transportation
p by Common Shipment
Carrier Destination
ElDisinterment 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
I- Remains are Shipped,If Other than Above
2 Address
cc
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/03/2022 Registrar of Vital Statistics fMeganWolin(E(ectronica((ySigned)
(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:
W Date of Disposition 4_V/tozz Place of Disposition ,Jp v,e,) er-eywc4oft4
(address)
W
/� (section) (lot number) (grave number)
Name of Sexton or Person in Charge of P miser / gt 1ad42
Z (please print)
W /
Signature �� Title � e..5-4 T0{—
DOH-1555(07/18)p t of 2
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i
_ 74 w --,,,•-• 0-t
Public Health Law Sec. 4145(2b)
Receipt
\
Human remains of ' ' ' k- t delivered on , 20 • `=
Pine View Cemetery Representing the funeral home named on t?ur41 permit
Official Funeral Directors Reg.or License#