Hartgraves, Kenneth L ,.,Ori)
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kenneth L.Hartgraves Male
Date of Death Age If Veteran of U.S.Armed Forces,
05/12/2023 90 Years War or Dales
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W i
Ci Manner of Death �I Natural Cause ] IAccident I Homicide ] ( ]
Suicide Undetermined Pending
W , `I f 'Circumstances I 'Investigation
U — -
W Medical Certifier Name Title
CI Vincent Cousineau Cote MD
Address
211 Church St,Saratoga Springs, New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 282
Burial Date Cemetery,Crematory or Facility Name
05/15/2023 Pine View Crematory
]Entombment --
Address
]Cremation Queensbury Town, New York
EDonation
Z❑Removal Date Place Removed
— and/or and/or Ileld
------------ ----------
N
Hold Address
0
d Date Point of
CO]Transportation
Ei by Common Shipment
Carrier Destination
Date Cemetery Address
]Disinterment
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
1— Remains are Shipped,If Other than Above
Address
CC
W - — —
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/15/2023 Registrar of Vital Statistics (lDihn Moran(G(ectr-m&tlp.Sgiiei/)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition _j z Place of Disposition ) Cteri �p�
w /(-2oz/ p r e </���
2 (addre.
W
N
CC (section) ,,/ 1(lot number) (grave number)
0 Name of Sexton or Person in Ch ge of Prerni. .s A 1 �1 ^� ', L�/OO _
Z G2� s (please print)
W Signature rr
DOH-1555(07/18)p 1 of 2
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#