Henke, Janice Elaine ELF, ,
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Janice Elaine Henke Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/17/2022 81 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Argyle Town Street Address 4723 State Route 40,Argyle Town,New York 12809
p Manner of Death ❑X Natural Cause Accident Homicide Suicide ElUndetermined Pending
W Circumstances Investigation
WMedical Certifier Name Title
i0 Kevin Gallagher MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 40
Burial Date Cemetery,Crematory or Facility Name
07/19/2022 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
OZ❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
O. Date Point of
U) Transportation
ES Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/19/2022 Registrar of Vital Statistics Slielrey Mckgrnon(ECectronically Signed)
(signature/
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 11701 Z2 Place of Disposition �ntV— +�.1�dr�..
a (address)
W
N (section) C1 (lot number) µ(grave number)
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Name of Sexton or Person in Charge of Pre i s 4i.. t
Z (pi a print) / ,�
W Signature — Title �"'���Tat
DOH-1555(07/18)p 1 of 2
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1 Public Health Law Sec. 4145(2b)
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1 Receipt
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I Human remains of - -` ' .. .:,---.L., delivered on ' ' , 20
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1 Pine View Cemetery Representing the funeral home named on burWipermit
I Official Funeral Directors Reg. or License# i 1 j/i/ cl