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Newell, John Allen . _ 11 ti51-7 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Allen Newell Male Date of Death Age If Veteran of U.S.Armed Forces, 04/13/2023 83 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc uJ p• Manner of Death �Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W• Medical Certifier Name Title in Philip Gara MD Address 319 Broadway, Fort Edward Town, New York 12828 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 40 Burial Date Cemetery,Crematory or Facility Name 04/24/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held f- Hold Address N 0 d Date Point of U)ElTransportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address El 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 1— Remains are Shipped,If Other than Above N Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/14/2023 Registrar of Vital Statistics Aimee G Mahoney(fCectronicarry Signed) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition q Izii I7,3 Place of Disposition -AL .r W (address) W CC CC (section) / (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises ^ u`—` '' Z (please print) W Signature Title ` VFollifp g_ DOH-1555(07/18)p 1 of 2 44.4 t a P 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#