Dennis, Thelma M 5 01
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Thelma M.Dennis Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/22/2022 81 Years War or Dates 1969-72
1— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
p Manner of Death a Natural Cause []Accident El Homicide []Suicide Undetermined Pending
W Circumstances Investigation
WMedical Certifier Name Title
CI 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 385
Burial Date Cemetery,Crematory or Facility Name
07/25/2022 Pine View Crematory
Entombment -Address
Cremation Queensbury Town,New York
Donation
❑and/or
Removal Date Place Removed
and/or Held
N Hold Address
0
CL Date Point of
t/)❑Transportation
by Common Shipment
Carrier Destination
o
Disinterment
Date Cemetery Address
ElReinterment 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
Remains are Shipped,If Other than Above
g Address
CC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/25/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(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:
Z Date of Disposition ?-7-5-zoy1.- Place of Disposition 1 V,(,y,) (rcr►+ orY
1!J (address)
W
CCCC (section) (lot number) (grave number)
G Name of Sexton or Person in Charge of Premises Tiff'e'y (Saii s
(please print)
W Signature 5/ "' Title Crt,,,'►o`to('
DOH-15551o7/t8)p t 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#