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Chatterton, Helen Marie
0 II 3 670 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Helen Marie Chatterton Female Date of Death Age If Veteran of U.S.Armed Forces, 04/08/2023 75 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death El Natural Cause []Accident D Homicide []Suicide Undetermined []Pending ✓ Circumstances ' 'Investigation GMedical Certifier Name Title Gamal Khalifa MD 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 184 Burial Date Cemetery,Crematory or Facility Name 04/20/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held H Hold Address CO 0 LL Date Point of f/) Transportation p by Common Shipment Carrier Destination o 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 N Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/10/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed) (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: Z �II W Date of Disposition ��IZl I'Z3 Place of Disposition `t �-.IL. �� 2 (address) W O (section) ��'lot number) � � (grave number) O Name of Sexton or Person in Charg fiP miles "�' l (ple se print) W � Titlei�", Signature DOH-1555(07/18)p 1 of 2 Y . I 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#