Ramsey, Katherine Dorothy i
_.._ LIF ' 4t1 to
1.')
NEWYORKSTATEDEPARTMENTOFHEALTH
�� Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Katherine Dorothy Ramsey Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/20/2022 90 Years War or Dates
1_ Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death []Natural Cause Accident []Homicide Suicide Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
CI Marcille Labban MD
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 643
Burial Date Cemetery,Crematory or Facility Name
12/21/2022 Pine View Crematory
Entombment Address
[]Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H N Hold Address
0
d Date Point of
Cl) Transportation
ES Common Shipment
Carrier Destination
El
Disinterment
Date Cemetery Address
Date Cemetery Address
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
1— Remains are Shipped,If Other than Above
N Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/21/2022 Registrar of Vital Statistics Megan Nolin(Electronically 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—
W 2 Date of Disposition / Z3..2�'LPlace of Disposition 7)' ie f,'e� �'/`ei,fA 'l•rat
(address)
W
Cl) (section) (lot number) (grave number)
O Name of Sexton or Person in Charge of P emis ---- t16Jt,.vb L.,O�)
(please pant//
W Signature Title De45 4%I -
DOH-1555(07/18)p 1 of 2
__ rr�y
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#