Bain, Loanne Muriel NEW YORKSTATE DEPARTMENT OF HEALTH - BUCIdl Transit Permit
Bureau►of Vital Records
i
Name First Middle Last Sex
Loannb Muriel Bain Female
Date of Death Age If Veteran of U.S.A_rme&Force's;
12/06/2022 85 Years War or Dates "
F Place of Death Hospital,Institution or
W City,Town or Village Glens Falls_ Street Address Glens Falls Hospital
`p Manner Death Natural Cause ❑Accident ❑HomicideSuicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Aaron Heckler PA
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 609
Burial Date Cemetery,Crematory or Facility Name
12/08/2022 m Pine View Creatory —
Entombment Address .—� __
Cremation Queensbury Town;New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
0- Date Point of
N 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
F- Remains are Shipped,If Other than Above
Address
W -
(' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/07/2022 Registrar of Vital Statistics SYlegan.NoCn(ECectronicalTySigned)
(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:
H
Z Date of Disposition 12Jg j.7,p Place of Disposition U r �
W
(address)
W
CO) (section) (lo//tnumber) (grave number)
23 Name of Sexton or Person in Charge of Premises
Z //ease print)
lL Signature Title �Ibn7
DO H-1555(07/18)p 1 of 2
0 63 7 3:1,
Public Health Law Sec. 4V,45(2b)
Receipt
Ij
Human remains of delivered on 20
Representing the fimeral home narned on burial permit
Pine View CemeterY, I
Official V, Funeral Directors Reg.or License#