Prosser, John Kevin NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John Kevin Prosser Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/20/2023 50 Years War or Dates
F,. Place of Death Hospital,Institution or
Z City,Town or Village Lake George Town Street Address 2354 Route 9 N Route,Lake George Town, New York 12845
Manner of Death Undetermined Pending
W Natural Cause Accident Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
CI David Mobarek MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed Town Of Lake George District Number Register Number
City,Town or Village 5651 24
Burial Date Cemetery,Crematory or Facility Name
01/24/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
ZZ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
a Date Point of
U)❑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-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
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 01/24/2023 Registrar of Vital Statistics Patricia XN1c1(inney-Schuster(E(ectronicaffySigned)
(signature)
District Number 5651 Place Town Of Lake George
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition J/15113 Place of Disposition -174IL dt r __
W
2 (address)
IIl)
CC U) (section) j (lot number) (grave number)
G Name of Sexton or Person in Charge of Premises ^` � vl
tease print)
W Signature Title ( 'v H I
DOH-1555(o7/18)pi of 2
G(3 3..-
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#