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Kosby, Kenneth John
�L .f) # 2/ NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kenneth John Kosby Male Date of Death Age If Veteran of U.S.Armed Forces, 03/03/2023 68 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W• Manner of Death Undetermined nPending W Circumstances Investigation W Medical Certifier Name Title CI Asim Chaudry 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 123 Burial Date Cemetery,Crematory or Facility Name 03/08/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation , OZ❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 CL Date Point of U)[]Transportation Q by Common Shipment Carrier Destination O Disinterment Date Cemetery Address EI 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 — Remains are Shipped,If Other than Above g Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/07/2023 Registrar of Vital Statistics ateganNoln(IYectronica(l Signer) (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: Z Date of Disposition 31 l01�3 Place of Disposition ,— `/It, W 2 (address) W N CC (section) (lot numbed-- (grave number) O Name of Sexton or Person in Charge of PreminLa�j�w ti'} Z 1print) IliSignature (please Title ` hw DOH-1555(o7/18)p 1 of 2 kO 15 7 4 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#