Hilder, Patricia Hilder , "---- a�
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Patricia Rose Hilder Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/04/2023 70 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
WI
Q Manner of Death ❑X Natural Cause Accident ri Homicide Suicide nUndetermined ❑Pending
W f 1Circumstances Investigation
W Medical Certifier Name Title
C Asim Chaudry 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 7
Burial
H
Date Cemetery,Crematory or Facility Name
01/06/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
g❑Removal Date Place Removed
and/or and/or Held
F— Hold Address
CO
0
CL Date Point of
N❑Transportation
p by Common Shipment
Carrier Destination
o
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
t- Remains are Shipped,If Other than Above
Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/06/2023 Registrar of Vital Statistics .Vegan t'' n(Ekctronicad:yswnea9
(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—
- V`. �'�t.'�
Z Date of Disposition 119 I t) Place of Disposition
2 (address)
W
CCCC (section) A (lot number) (grave number)
rr
O Name of Sexton or Person in Ch Premises "/, < 1---'
Z / (p se print)
W Signature Title ��'� '�
DOH-1555(07/18)p 1 of 2
Via ,. 6576
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#