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Hannah, Shirley Amelia , ...i.q...";::F) 11- 7Z° NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Shirley Amelia Hannah Female Date of Death Age If Veteran of U.S.Armed Forces, 03/04/2023 84 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Ill 0 Manner of Death a Natural Cause Accident [IIHomicide Suicide nUndetermined ❑Pending ILLI U IlCircumstances Investigation III 0 Medical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 124 BurialF Date Cemetery,Crematory or Facility Name 03/08/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held l Hold Address N 0 n- Date Point of V)nTransportation (� by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment Date Cemetery Address 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 1— Remains are Shipped,If Other than Above i Address CC W Cl. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/07/2023 Registrar of Vital Statistics Megan NOlin(Electronicall:y Signe4 (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 3 Ile( U� Place of Disposition ram, (L.-*r.�. 2 (address) W U) CC (section) 7 (lot number/ (grave number) dName of Sexton or Person in Charge of Pre r es "' �— It z (ptase print) W Signature Title ` � '�IW DOH-1555(07/18)p 1 of 2 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#