Russell, Geraldine Marie tt
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Geraldine Marie Russell Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/28/2023 62 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address 343 Pleasant Valley Road,Argyle Town, New York 12809
WW Manner of Death
Natural Cause Accident Homicide Suicide Undetermined ri Pending
I—IU Circumstances Investigation
Q Medical Certifier Name Title
Robert Lemieux Coroner
Address
415 Lower Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 5
Burial Date Cemetery,Crematory or Facility Name
01/30/2023 Pine View Crematory
Entombment Address
IIICremation Queensbury Town,New York
Donation
ZZ Removal LI Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
N Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
C Reinterment
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
— Remains are Shipped,If Other than Above
Address
CC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/30/2023 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 1130(0 Place of Disposition
UJ (address)
2
W
N (section) � (lot number/ (grave number)
0 0L -}
Name of Sexton or Person in Ch rge of Premises `�`�'� `
z lease print)
W Signature Title
DOH-1555(07/18)p i of 2
it
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#