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Peterson, Sylvia Ann ff) Z3 b NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sylvia Ann Peterson Female Date of Death Age If Veteran of U.S.Armed Forces, 03/12/2023 88 Years War or Dates F- Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare w Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide U Circumstances Investigation W Medical Certifier Name Title 0 Brandii Baker 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 16 Burial Date Cemetery,Crematory or Facility Name 03/13/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 a Date Point of Cl)LJTransportation p by Common Shipment Carrier Destination EI Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom E- Remains are Shipped,If Other than Above Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/13/2023 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: I— WDate of Disposition 3)IH 173 Place of Disposition -I!,.,,�L __ a (address) W NCC (section) 4 (lot number) (grave number) 0rt Name of Sexton or Person in Ch2remi of ses Z '`-lase print) W Signature Title � ' `� DOH-1555(07/18)p 1 of 2 + ,. L Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on bµria1 permit Official Funeral Directors Reg.or License# !t I {