Rabe, Louise Audrey ti®,
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NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit )3)
Bureau of Vital Records
Name First Middle last Sex
Louise Audrey Rabe Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/16/2022 95 Years Waror Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Milton Town Street Address Gateway House of Peace
Mannerof Death EINaturalCause Accident Homicide Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Lynn Keil PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town of won District Number Register Number
Cit ,Town or VillageE 4561 38
Burial Date Cemetery,Crematory or Facility Name
09/1912022 Pine View Crematory
Entombment Aduress
Cremation Queensbury Town,New York
DDonation
❑Removal Date Place Removed
and/or and/or Held
CO Hold Address
0
O. Date Point of
(/) Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
LI
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kikner 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
—. Remains are Shipped,If Other than Above
2 Address
IX
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/19/2022 Registrar of Vital Statistics Ott 4 ffervegisatnnicaaj,Signs4
(signature/
District Number 4561 Place Town Of Milton
I certify that the remains of the decedent identified above were disposed of in accordance with this penniton:
WDateof Disposition i Iz0I lZ Place of Disposition .�,c�, 1.,71-ot--�2 (address)
ILI
Q (section) (lot number) c (gra*number)
S Name of Sexton or Person in Charge of Premises 11 D t t__ 1
ft
Z (plra�print/
W TOC
Signature Lam' Title � m�
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of • delivered on , 20
Pine View Cemetery Representing the funeral home named on bur01 permit
Official Funeral Directors Reg.or License# . -