Kuebler, Kay L •NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Kay L Kuebler Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/25/2022 86 Years War or Dates
1— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
p ent Homicide Manner of Death Et Natural Cause ❑Accid � Suicide Undetermined ❑Pending
W Circumstances Investigation
U
QW Medical Certifier Name Title
Wendy Steinhacker PA
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 439
Burial Date Cemetery,Crematory or Facility Name
08/26/2022 Pineview Crematory
Entombment Address
ZCremation Queensbury Town,New York
Donation
O Removal Date Place Removed
H and/or and/or Held
N Hold Address
0
Q. Date Point of
CO■Transportation
ES by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
■Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
-. Remains are Shipped,If Other than Above
a Address
W
d Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/25/2022 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:
I�-
Z Date of Disposition 9�'e.`�..jp Place of Disposition sp,y� v:1 L C ,A y
(address)
2
W
N
(section) (lot number) (grave number)
O Ter
Name of Sexton or Person in Charge of Premises ;JLS
Z (please print)
W Signature "941,41N Title
DOH-1555(o7/t8)p t of 2
Public Health Law Sec. 4145(2b)
Receipt
1
Human remains of delivered on , 20
'Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#