Thomas, Judy Lynn NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Judy Lynn Thomas Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/23/2023 61 Years War or Dates
▪ Place of Death Hospital,Institution or
W City,Town or Village Salem Town Street Address 86 Tug Hollow Road,Salem Town,New York 12873
p Manner of Death El Natural Cause Accident ❑Homicide []Suicide nUndetermined []Pending
W Circumstances I 'Investigation
W Medical Certifier Name Title
0 Charles Yun MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Salem District Number Register Number
City,Town or Village 5764 1
Burial Date Cemetery,Crematory or Facility Name
01/27/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
['Donation
Removal Date Place Removed
and/or and/or Held
H Hold Address
to
0
Date Point of
U) Transportation Shipment
G by Common
Carrier Destination
Date Cemetery Address
['Disinterment
Date Cemetery Address
[]Reinterment
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
H Remains are Shipped,If Other than Above
2 Address
CC
W
E' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/27/2023 Registrar of Vital Statistics etrrcia/7ciklirGrt(EYectrorrrcally,*tree0
(signature)
District Number 5764 Place Town Of Salem
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F-
W Zc'Date of Disposition /—?t '3Place of Disposition e , E ) C r-C-/n4 c 2 (address)
W
CC CC (section) (lot number) (grave number)
J I
G Name of Sexton or Person in Charg f Pre is = hatt m! ,� L 0iJeL
Z ' (please print)
lL Signature fir Title 0 V 4-
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
r F
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ti j.