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Bain, Janice Nina 301 ) NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Janice Nina Bain Female Date of Death Age If Veteran of U.S.Armed Forces, , 05/01/2023 81 Years War or Dates p Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 11.1 p Manner of Death El Natural Cause Accident []Homicide []Suicide FlUndetermined []Pending W U Circumstances I ,Investigation W Medical Certifier Name Title CI Kristen Kelley DO 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 224 RBurial Date Cemetery,Crematory or Facility Name 05/03/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed - and/or and/or Held F-- Hold Address N 0 O. Date Point of N❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above N Address CC Ill O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/02/2023 Registrar of Vital Statistics MeganNolin gkctronicall:y Signer,) (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: F— (� '*tt-�'\ Z Date of Disposition '��S' Z "` 3 Place of Disposition 4 V�^" 2 (address) W CO (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pre ' s e it Z vase riot/ if W Signature � Title �� '. ��� 7 DOH-1555(07/18)p 1 of 2 r ..� Pam' ..,1 4 0 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#