Prevost, Alexander G #. j
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Alexander G.Prevost Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/05/2022 32 Years War or Dates
i- Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 56 Leonard Street,Glens Falls,New York 12801
p Manner of Death n Natural Cause Accident ❑Homicide 0Suicide [ lUndetermined ❑X Pending
W
0I (Circumstances Investigation
W Medical Certifier Name Title
CI Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 606
Burial Entombment Date Cemetery,Crematory or Facility Name
12/07/2022
Address Pine View Crematory
— — ----- — — --— --
EICremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
G. Date Point of
N❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
0 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
2 Address
CC
W
O" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/06/2022 Registrar of Vital Statistics legan.NolingYectronicallySne4
(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:
F_' -�-�
W Date of Disposition it Ft IZ Place of Disposition 1 At
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2 (a ress)
W
Cl)CC (section) /f (lot numbed (grave number)
st,
g Name of Sexton or Person in Charge of Premises °IL,z
�1 (pa print)
W Signature Lam"'` Title (-0/6r ti
DOH-1555(07/18)p 1 of 2,,
se
Public Health Law Sec. 4145(2b) 1 0
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#