Wilson, Julia Ann LF _�
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Julia Ann Wilson Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/13/2022 83 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Village Street Address 167 East Street, Fort Edward Village, New York 12828
• Manner of Death X Natural Cause Accident ri Homicide nSuicide nUndetermined ❑Pending
W Circumstances Investigation
W D Medical Certifier Name Title
Curtis Gedney MD
Address
454 Glen Street,Glens Falls,New York 12801
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 49
Burial Date Cemetery,Crematory or Facility Name
06/18/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
N~ Hold Address
0
Q. Date Point of
N 1Transportation
CI 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
5 Address
CC
W _
CL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/14/2022 Registrar of Vital Statistics Aimee L 9Ka/oney('(ectronica(CySigned)
(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:
i—
Z Date of Disposition -1BZp2c. Place of Disposition IF;AJeIJJ
2 (address)J
WI
U)
CC (section) / (lot n ther)t (grave number)
• Name of Sexton or Person in Charge o Premis s'/ l�4� /�10�b �. OC�C
Z (please print)
W nature Si
g c:/1 / Title j)Piefot*�
DOH-1555(07/18)p 1 of 2
_
Public Health Law Sec. 4145(2b) 0 '
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#