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St. Denis., Wilfred C
_. @ tt 3,4I N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Wilfred C.St.Denis Male Date of Death Age If Veteran of U.S.Armed Forces, 04/12/2023 71 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village South Glens Falls Village Street Address 52 Main Street 4,South Glens Falls Village,New York 12803 LU ▪ Manner of Death Natural Cause Accident n Homicide nSuicide Undetermined ❑Pending W I Circumstances Investigation W• Medical Certifier Name Title a Christopher Mason DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Village Of South Glens Falls District Number Register Number City,Town or Village 4524 9 ▪Burial Date Cemetery,Crematory or Facility Name 04/14/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York IIIDonation 0❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of to Dransportation Shipment by Common Carrier Destination Date Cemetery Address Disinterment 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 l— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/13/2023 Registrar of Vital Statistics Matthew Espey(Electronically Signed) (signature) District Number 4524 Place Village Of South Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H r Z Date of Disposition ��/5-'7a7�Place of Disposition n1( t✓t r',r> C, BJ (address) W Cl) (section) // (lot nuf berg (grave number) g Name of Sexton or Person in Charge Premi f/"u'`'� A"`�0 (please print) W Signature Title o�i� DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) 0i � Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#