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Gibbs, Judie Ellen t isg NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Mi Last Sex Judie Ellen Gibbs \ Female Date of Death Age If Vetera 03/23/2023 77 Years War or D. i_ Place of Death . vital, • titution or Z City,Town or Village Granville Town ..ress Slate Valley Center for Rehabilitation and Nursing W Manner of Death Natural Cause ElAccident Undetermined Pending W U Homicide Suicide Circumstances Investigation W Medical Certifier Name Title CI Joshua Starteri NP Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed Town Of Granville District Number Register Number City,Town or Village 5756 12 Burial Date Cemetery,Crematory or Facility Name 03/27/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York ElDonation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 Date Point of U)❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment O 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 F— Remains are Shipped,If Other than Above i" Address CC n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/27/2023 Registrar of Vital Statistics Jenny Linda M Iklartelle(Electronically Signed) (signature) District Number 5756 Place Town Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 3 131 113 Place of Disposition jv r� W (address) W CC (section) Xr,w. J (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises L" � At} Z (j.lease print/ WTitle � � Signature 7:.,,r DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) ;v Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# `.`