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Gray, Rosann Louise 0 1!) NEW YORK STATE DEPARTMENT OF HEALTH � zo � Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Rosann Louise Gray Female Date of Death Age If Veteran of U.S.Armed Forces, 02/28/2023 94 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare WManner of Death ❑^ Natural Cause Accident I I Homicide nSuicide Undetermined Pending V Circumstances Investigation W Medical Certifier Name Title a Joshua Starteri NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 13 EBurial Date Cemetery,Crematory or Facility Name 03/01/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York CDonation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 U. Date Point of t/)OTransportation Shipment Q by Common Carrier Destination nDisinterment Date Cemetery Address Date Cemetery Address Reinterment 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 a Address It W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/01/2023 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: ~ �kW Date of Disposition 3)Z i"Z, Place of Disposition -(� V 2 (address) W CO (section) /i ; L- f(lotnumber) (grave number) Name of Sexton or Person in Charge - fl z /plea print) / W Signature Title l�0�"�P2 DOH-1555(07/18)p 1 of 2 F 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#