Cosner, Jennifer Ellen A1,-oic ,
NEVORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jennifer Ellen Cosner Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/16/2022 58 Years War or Dates
i_ Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address 8 Bacon Street 3,Glens Falls,New York 12801
p Manner of Death ❑K Natural Cause IllAccident ❑Homicide Suicide FlUndetermined ElPending
W
C.) Circumstances I 'Investigation
W Medical Certifier Name Title
CI Connie Goedert Coroner
Address
50.St Route 9,Lake George Town,New York 12845
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 579
Burial Date Cemetery,Crematory or Facility Name
11/18/2022 Pine View Cremator;
Entombment Address
Cremation Queensbury Town,New York
Donation
ZZ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
Date Point of
N ElTransportation Shipment
5 .„„,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
1— Remains are Shipped,If Other than Above
5 Address
CC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/18/2022 Registrar of Vital Statistics gfeganXoin ctronrcalySWneI
(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 /J-/ -ZCZ.. Place of Disposition ? rJ e iJ e ) C-eiv,4 P
W (address)
W
CC (section) (lot numbe) (grave number)
CC
O ci
• Name of Sexton or Person in Charge of Premises I �,�14�s��(pteasepr /
W Signature . /-s17 1(Ir
Title
DOH-1555(o7/i8)p id 2
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# � /