Hill, Retha Ellen ..5 it 07,
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Retha Ellen Hill Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/13/2022 58 Years War or Dates
F Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death ❑X Natural Cause IllAccident Homicide Suicide Undetermined Pending
V Circumstances Investigation
W Medical Certifier Name Title
0 Marvin Davidowitz 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 420
ElBurial Date Cemetery,Crematory or Facility Name
08/15/2022 Pine View Crematory
Entombment Address
▪Cremation Queensbury Town,New York
▪Donation
g 0 Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
CI. Date Point of
(I)OTransportation Shipment
Q by Common
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-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
l. Remains are Shipped,If Other than Above
a Address
CC
Iii
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/15/2022 Registrar of Vital Statistics Megan. rofin(ECectronica1TySigned)
(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 ZL, -
W Date of Disposition $(ls l lc Place of Disposition
2 (address)
W
ID
CC (section) //Int
(lotnum� (grave number)
g Name of Sexton or Person in Charge of mises �Q�
Y (please print)
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IL Signature Title � � `�
DOH-1555(07/18)p 1 of 2
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Public Health Law Sec. 4145(2b) 1°
Receipt
•
Human remains of delivered on , 20
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Pine View Cemetery Representing the funeral home named on burr permit
Official Funeral Directors Reg.or License# Fi E