Malone, Linda Elizabeth .�
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Linda Elizabeth Malone Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/04/2022 68 Years War or Dates
H Place of Death Hospital,Institution or
WCity,Town or Village South Glens Falls Village Street Address 7 Haviland Avenue,South Glens Falls Village,New York 12803
p Manner of Death ❑X Natural Cause Accident 0 Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
CI Sean Campanie NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Village Of South Glens Falls District Number Register Number
City,Town or Village 4524
EBurial Date Cemetery,Crematory or Facility Name
08/05/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
goRemoval Date Place Removed
and/or and/or Held
H Hold Address
N
0
d Date Point of
t/)❑Transportation
p by Common Shipment
Carrier Destination
o
Disinterment
Date Cemetery Address
0 Rei nterment
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
a Address
Q
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/05/2022 Registrar of Vital Statistics Samantha Berg(Electronically Signed)
(signature)
District Number 4524 Place Village Of South Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1-
W Date of Disposition O,Q�ctOZ2 Place of Disposition 'la e_ 14 e_4,i) ef-- l 3
2 (address)
W
N
Cr (section) ,/ f llo umbe (grave number)
CName of Sexton or Person in Char Premi s ' ���7 �n� C G�c
z ,f please print/
W Signature Title Oem�T15-
DOH-1555(07/18)p i of 2
I __ . 1,6°_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#