Kobor, Claudia Rose — 85Z
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Claudia Rose Kobor Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/08/2023 84 Years War or Dates
F Place of Death Hospital,Institution or
2 City,Town or Village Queensbury Town Street Address 4 Par Place D,Queensbury Town,New York 12804
W Manner of Death Undetermined Pending
W Natural Cause nAccident I n Homicide Suicide I
V Circumstances Investigation
W Medical Certifier Name Title
G Aimee Mcmaster NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 56
Burial Date Cemetery,Crematory or Facility Name
04/12/2023 Pine View Crematory
Entombment Address
nCremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
I Hold Address
N
0
a. Date Point of
U)Dransportation
p by Common Shipment
Carrier Destination
O
Disinterment
Date Cemetery Address
Date Cemetery Address
0 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
E— Remains are Shipped,If Other than Above
a Address
CC
W
0" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/11/2023 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition yiIZ IZ.3 Place of Disposition ('[ l.r�)
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add 2
IW
Q (section) (lot numb (grave number)
8 Name of Sexton or Person in Charge of Pr ises At.,L l II
please print)
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tU Title r�'m41N
Signature
DOH-1555(07/18)p 1 of 2
6 1
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#