Grinnell, Denise Ann #
III
NEWYORKSTATEDEPARTMENTOFHEALTH - Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Denise Ann Grinnell Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/01/2023 70 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 516 Gansevoort Road, Moreau Town, New York 12828
Manner of Death Undetermined Pending
El Natural Cause Accident Homicide Suicide g
W Circumstances Investigation
Medical Certifier Name Title
CI Gerard Abess MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Moreau District Number Register Number
City,Town or Village 4562 7
Burial Date Cemetery,Crematory or Facility Name
02/03/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
i Hold Address
N
0
ia. Date Point of
(I) Transportation
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
F.. 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 02/03/2023 Registrar of Vital Statistics Leeann McCa6e(rCectronicalfy Signed)
(signature)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:Z Date of Disposition ) 7—' to4.3 Place of Disposition A. (P jr, A-10 t--
2 (address)
W
CC CC (section) (10 numb r) (grave number)
O Name of Sexton or Person in Charge of remi es �f!I�n�oN Air
0 (please print)
Z
W Signature Title
DOH-1555(07/18)p 1 of 2
r
Public Health Law Sec. 4145(2b)
Receipt
1
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#