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Ertter, Kathleen D �1F � 3s 1. , NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathleen D Ertter Female Date of Death Age If Veteran of U.S.Armed Forces, 04/15/2023 62 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death IZI Natural Cause Accident 0 Homicide ESuicide FlUndetermined ri Pending W Circumstances Investigation UU,i Medical Certifier Name Title G Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 200 EIBurial Date Cemetery,Crematory or Facility Name 04/19/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York 0Donation F❑Removal Date Place Removed and/or and/or Held ~ Hold Address CO Off. Date Point of Cl)❑Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above a Address Cr W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/18/2023 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:/ �,� Date of Disposition Li ill l j; Place of Disposition ' I '�JL N��'__--_ 2 (address 111 Cl) 5.: (section) (lot number) (grape number) gName of Sexton orPersonin Charge of Premises A^ i" i(t Ch please print) z (C�smiiN�ti W Signature Title DOH-1555(07/18)p 1 of 2 : .l P _. 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 • Funeral Directors Reg. or License#