Francett, Colin Vincent ' --
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STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Colin Vincent Francett Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/06/2022 60 Years War or Dates
f.. Place of Death Hospital,Institution or
Z City,Town or Village Kingsbury Town Street Address 1771 Hinds Road,Kingsbury Town,New York 12828
fW
Q Manner of Death El Natural Cause Accident ❑Homicide OSuicide Undetermined ❑Pending
U Circumstances Investigation
G Medical Certifier Name Title
Donald Merrihew MD
Address
319 Bay Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Kingsbury District Number Register Number
City,Town or Village 5762 19
Burial Date Cemetery,Crematory or Facility Name
10/07/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z• Removal Date Place Removed
and/or and/or Held
F- Hold Address
CO
0
O. Date Point of
CO❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
a Address
IX
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/07/2022 Registrar of Vital Statistics Cynthia A cBardin(Ehctronica1TySigned)
(signature)
District Number 5762 Place Town Of Kingsbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition /Q^g—Z(>ZZPlace of Disposition ? e 1) • .,Nf r 4-to r13
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2 (address)
W
CO
CC (section) (lot nu ber) (grave number)
gName of Sexton or Person in Charge of Premises ,/ �ln/�,/dliU:v GJ
z (please print)
W c 'Signature I� l 6V Title Offal.- i
DOH-1555(o7/t8)p 1 of 2 T
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Public Health Law Sec. 4145(2b)
1
1
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#