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NEW YORK STATE DEPARTMENT OF HEALTHtl� ,,, Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Linda Constance Kintzing Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/10/2022 76 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 00 Robert Gardens,Queensbury Town,New York 12804
p Manner of Death Ei Natural Cause Accident IIIHomicide Suicide Undetermined Pending
W
C.) Circumstances Investigation
W Medical Certifier Name Title
G Agee!Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 170
Burial Date Cemetery,Crematory or Facility Name
11/15/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
- and/or and/or Held
~- Hold Address
N
0
d Date Point of
N['Transportation Shipment
p by Common
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
C 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
F- Remains are Shipped,If Other than Above
N Address
Ir
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/14/2022 Registrar of Vital Statistics Caroline.7iigardi Surber-(EYectronicallySigned)
(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:
I—
Z WDate of Disposition Ay I71 Place of Disposition .. I-- rw ---
2 (address/
W
CCCC (section) (lot number, ytt (grave number)
0 Name of Sexton or Person in Charge of Premisesg ___ _________:. t' i'`
Tease print)
W Title (17 �
Signature
DOH-1555(o7/18)p t of 2
Public Health Law Sec. 4145(2b) '` 3
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#