Fellows, Paul William , 0- ill
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NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Paul William Fellows Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/03/2022 89 Years War or Dates 1951-1954
F.. Place of Death Hospital,Institution or
W City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
O Manner of Death El Natural Cause Accident EI Homicide Suicide FlUndetermined riPending
W Circumstances Investigation
W Medical Certifier Name Title
0 Wendy Steinhacker PA
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 143
Burial Date Cemetery,Crematory or Facility Name
® 10/04/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
CO
0
n. Date Point of
U)❑Transportation Shipment
p by Common
Carrier Destination
o
Disinterment
Date Cemetery Address
OReinterment 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
}— Remains are Shipped,If Other than Above
a Address
CC
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/04/2022 Registrar of Vital Statistics Caroline xlfegarde Barber(EtectronicalTySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 7
Zc(W Date of Disposition IO 1 ZZ Place of Disposition �/h
2 (address)
W
CO CC (sedion) d;lo,„„cr, .s.t., (grave number)
S Name of Sexton or Person in Charge of Premises v7 �QQ
sk print) 9
Signature e
W �i<
Z (ple Titl JJ ` (v
DOH-1555(07/18)p 1 of 2
1 7° 'CI
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#