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NEW YORKSTATE DEPARTMENT OF HEALTH �°��_. Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
August Heinrich Popall Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/13/2022 90 Years War or Dates 1951-65
F,. Place of Death Hospital,Institution or
WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
p Manner of Death Ili Natural Cause Accident El Homicide Suicide nUndetermined ri Pending
W
U Circumstances Investigation
W Medical Certifier Name Title
CI Carrie Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 76
RBurial Date Cemetery,Crematory or Facility Name
10/17/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 IJ Removal Date Place Removed
and/or and/or Held
F Hold Address
N
0
G. Date Point of
CO['Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment 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
H Remains are Shipped,If Other than Above
"g Address
LC
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n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/17/2022 Registrar of Vital Statistics Aimee C.Mahoney(ECectronica1Ty Signed)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
— (L
Z Date of Disposition 10(I$(1 j Place of Disposition �'-a ,/}-o—___
W (address)
IILI
NCC (section) A (lot number) (grave number)
0 Name of Sexton or Person in Char of Premises r`' r,...... S ^Alt
Z (pleaprint)
W Signature Title 0760)0`2
DOH-1555(07/18)p 1 of 2
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Public Health Law Sec. 4145(2b)
Receipt
Human remains of 's :�, delivered on , 20
Pine View Cemetery Representing the funer'ai home named on burial permit
Official al Directors Reg.or License# % ,`