Amando, Kim A CF,
j �`ova
NEW YORK STATE DEPARTMENT OF HEALTH r Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kim A.Armando Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/24/2022 65 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
O Manner of Death ❑X Natural Cause ❑Accident ❑Homicide OSuicide nUndetermined riPending
W Circumstances Investigation
W Medical Certifier Name Title
O Matthew Loftus PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 654
Burial Date Cemetery,Crematory or Facility Name
12/27/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
DDonation
4 L__1 Removal Date Place Removed
and/or and/or Held
CO Hold Address
0
O. Date Point of
M Transportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
EReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
a Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/27/2022 Registrar of Vital Statistics JKegan Wolin(ECectronicaQySigned)
(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:
Date of Disposition /Z-Z12c>2- Place of Disposition V" JO tJ,C,..) Creota`4 t`A
2 /addreesY
W
CC (section) (lot nymber) (grave number)
g l<AY�r r G��r�e1
Name of Sexton or Person in Charge of Prers s
j/ (please print)
1U Signature �� Title � '�- t
DOH-1555(07/18)p 1 of 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#