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Heflin, Wilbur Mitchell It G # 33b NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Wilbur Mitchell Heflin Male Date of Death Age If Veteran of U.S.Armed Forces, 04/09/2023 58 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Hebron Town Street Address 1020 Callaway Road,Hebron Town,New York 12809 ill pManner of Death 1=1 I I Natural Cause Accident Homicide Suicide Undetermined Pending ✓ I 'Investigation 'Investigation U.IQ Medical Certifier Name Title Kristen Kelley DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Hebron District Number Register Number City,Town or Village 5760 5 Burial Date Cemetery,Crematory or Facility Name 04/13/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held l— N Hold Address • 0 CL- Date Point of N oTransportation p by Common Shipment Carrier Destination Date Cemetery Address nDisinterment Reinterment Date Cemetery Address 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 Address CC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/13/2023 Registrar of Vital Statistics Dorothy Worthington(Electronicalr Signer!) (signature) District Number 5760 Place Town Of Hebron I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— f Z Date of Disposition 9ley 1 Z 5 Place of Disposition '(1„AL !�fi,.... 111 2 (address) W Cl) (section) (lot number) (grave number) CC Name of Sexton or Person in Charge o emises / rv�pL— I•t{" Z (p se print) W Signature Title G f'"Poi ,1 DOH-1555(o7/18)p id 2 Public Health Law Sec. 4145(2b) c Receipt Human remains of delivered on , 20 .... Pine View Cemetery Representing the funeral home named,on,buzial permit Official Funeral Directors Reg.or License#