Bain, Loanne Muriel /jf to I
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital.Records
Name First Middle Last Sex
Loanne Muriel Bain Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/06/2022 85 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
UJ
p Manner of Death El Natural Cause ❑Accident El Homicide ESuicide nUndetermined ❑Pending
W
U Circumstances Investigation
ILL Medical Certifier Name Title
CI Aaron Heckler 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 609
EBurial Date Cemetery,Crematory or Facility Name
12/08/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
Q. Date Point of
(I) Transportation Shipment
Q 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-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
2 Address
LE
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/07/2022 Registrar of Vital Statistics Megan Wolin(cCectronica1TySigned)
(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 12141 zz Place of Disposition l ',µU. c0—
2 (address)
W
NLC (section) /l (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises (/rl1 r" (,�
0 (�j lease print)
ZZiP ;ix
W Signature Title � 1
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#