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Sobell, Henry Martinique , 13S NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Henry Martinique Sobell Male Date of Death Age If Veteran of U.S.Armed Forces, 03/11/2023 87 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 Pending W Natural Cause Accident Ei Homicide Suicide Circumstances Investigation W Medical Certifier Name Title CI Matthew Loftus PA 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 133 ElBurial Date Cemetery,Crematory or Facility Name 03/13/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held ~ Hold Address (A 0 G. Date Point of Cl)❑Transportation p by Common Shipment Carrier Destination Disinterment 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 H Remains are Shipped,If Other than Above g Address CC W Q. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/13/2023 Registrar of Vital Statistics 9vtegan Wolin(ElectronicallySigned) (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 3I/`1 173 Place of Disposition 'j VL /. L 2 (address) W U)CC (section) /� (lot number) (grave number) Name of Sexton or Person in Charge of Pr ises (/ • ..— )1- Z please print) W Signature Title DOH-1555(07/18)pi 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#