Duval, Pauline Margaret NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Pauline Margaret Duval Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/14/2022 74 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
LLJ
p Manner of Death El Natural Cause Accident El Homicide ESuicide FlUndetermined Frending
W Circumstances Investigation
W Medical Certifier Name Title
CI Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 569
Burial Date Cemetery,Crematory or Facility Name
11/15/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
O❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
Date Point of
U)❑Transportation Shipment
p by Common
Carrier Destination
O
Disinterment
Date Cemetery Address
El Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
CC
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/14/2022 Registrar of Vital Statistics Megan No(in(ECectronica((y Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-
Z Date of Disposition IRIS 17t Place of Disposition %�L-
(� (ad ess)
W
N (section) (lot number) (grave number)
CC
Name of Sexton or Person in Charge of Pre ' es I Ilat..,
v l't
Z se print)
Z C' '11
LtJ Signature Title
DOH-1555(07/18)p 1 of 2
3 1. ..i 3 9 9
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#