Cottrell, JoAnn Theresa be � r # flS
NEW YORK STATE DEPARTMENT OF HEALTH '' '
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
JoAnn Theresa Cottrell Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/24/2022 79 Years War or Dates
I— Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address St Peters Hospital
LU
p Manner of Death El Natural Cause Accident 0Hornicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
WMedical Certifier Name title
CI Edward Conuel DO
Address
315 S Manning Blvd,Albany,New York 12208
Death Certificate Filed City Of Albany District Nur 2r Register Number
City,Town or Village 0101 2218
Burial Date Cemetery,Crematory or Facility arse
09/30/2022 Pine View Crematory
9Lntornbrnent "Address
Cremation Queensbury Town.New York
,Don ation
Z Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
C. Date Point of
U)❑Transportation
ES Common Shipment
Carrier Destination
Date Cemetery Address
DDi si nterrnent
Date Cemetery Address
El Reinterment
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
l— Remains are Shipped,If Other than Above
g Address
CC
uJ
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/27/2022 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed)
(signature)
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on; /2},
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W Date of Disposition �I Z�I7Z Place of Disposition i.,.� ,,,_, r-�
2 (address)
W
Q (section) A
(lot number) (gm ve number)
0 Name of Sexton or Person in Charge f Premises �O M�ti
Z (pease print/
w Signature Title r /6 HA(
DOH 1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
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1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
Lot No. 7
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Section No.
Address
36 Homer Ave QuPPnshtiry, NY 17R(14
Owner Frig Pr,ttrall Plot e
Date 6/3/2015
Superficial ft.
Apprnx SI_ Ft.
Location EinnuOPa nrl North by Path, South by Vacant -
East by Vacant and WPst Jy Variant/Cnttrcl 1
Corner Posts
Remarks ea-La ) — SIBS - eo d, - 19 0 i etic ;
Deed No. (and changes) 3905
Payment Record paid in r ull, 5400
Record of Interments -TD9 i G rzVC 5
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COTTRELL
NAME JoAnn Cottrell LF Age: 79
Lot Owner: Eric Cottrell
Lot# Erie 22 B Grave# 3 B
Case: Urn
Died: 9.2 4.2 2 Interred: 9.3 0.2 2
Funeral Home: M B. Kilmer FH
Cemetery: Pine View