Newell, Alice Kathleen _ , 1.. F 7OLJ
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Last Sex
Middle
Name First Female
Alice Kathleen Newell
Date of Death Age If Veteran of U.S.Armed Forces,
09/04/2022 89 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
W Manner of Death Undetermined nPending
`p D Natural Cause Accident Homicide Suicide nCircumstances ' 'Investigation
W Medical Certifier Name Title
CI Brandii Baker NP
Address
4573 State Route 40,Argyle Towi%New York 12809
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 49
RBurial Date Cemetery,Crematory or Facility Name
09/06/2022 Pine View Crematory
Entombment Address
nCremation Queensbury Town,New York
Donation
ZZ❑Removal Date Place Removed
- and/or and/or Held
F-- Hold Address
N
0
Date Point of
(A❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
0 Reinterment
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
H Remains are Shipped,If Other than Above
2 Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/06/2022 Registrar of Vital Statistics Shelley Mckernon(E(ectronicaCCy 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:
H 4....._
W Date of Disposition 11 72 Place of Disposition 't 'u�
(address)
W
NIX (section) fiat�ber/ (grave number)
O Name of Sexton or Person in Charge of r ises /fln
, '„,.....itt
Z ( ase print)
Z � rn�
W Signature Title
g
DOH-1555(o7/t8)p 1 of 2
0�y 6216
a..
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#