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Janson, Karen Louise Pt S22 @I , NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Karen Louise Jansson Female Date of Death Age If Veteran of U.S.Armed Forces, 06/24/2023 67 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death � W NaturalCause Accident nHomicide n n Suicide Undetermined ❑Pending C) I ''Circumstances Investigation LU Medical Certifier Name Title Marcille Labban MD 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 312 Burial Date Cemetery,Crematory or Facility Name 06/27/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation ZO�Removal Date Place Removed and/or and/or Held H Hold Address N 0 d Date Point of Cl)❑Transportation p by Common Shipment 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 g Address CC W O.. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/26/2023 Registrar of Vital Statistics Megan NolngYectronicall:y Signe4 (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: I— ----, & Z Date of Disposition 4,1 3 1",3 Place of Disposition -rUL 2 (address) W CC CC (section) lot number) (grave number) 0 Name of Sexton or Person in Charge of ises /LL- —kv z (ple se print) W Signature Title r ��� DOH-1555(07/18)p 1 of 2 l' Public Health Law Sec. 4145(2b) ", "„ 1 Receipt 1 Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#