Rowley, Christine Myra ' 11lig
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Christine Myra Rowley Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/08/2022 51 Years War or Dates
i_ Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 7 Paul's Way,Queensbury Town,New York 12804
p Manner of Death ❑X Natural Cause Accident ❑Homicide []Suicide FlUndetermined Pending
W
I—I
U Circumstances Investigation
W Medical Certifier Name Title
CI Darci Gaiotti-Grubbs MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 97
ElBurial Date Cemetery,Crematory or Facility Name
06/11/2022 Pine View Crematory
Entombment Address
▪Cremation Queensbury Town,New York
▪Donation
8❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
d Date Point of
Cl)❑Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
0 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
N Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/10/2022 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:
I—
W Date of Disposition V�kk in Place of Disposition •�a(IL. '�-
(address)
W
U)
CC (section) (lot.number) }�(grave number)
1441......
• Name of Sexton or Person in Charge of P emises 'oi
Q / e print)/�
W Signature ...,�(" Title • rolai C
DOH-1555(07/18)p 1 of 2
01
Public Health Law Sec. 4145(2b)
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Receipt
Human remains of °'' delivered on , 20
Pine View Cemetery Representing the funeral home named Qn burial permit..
Official Funeral Directors Reg.or License#