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Klam. Paul Herbert
) # 5-St( NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Paul Herbert Klam Male Date of Death Age If Veteran of U.S.Armed Forces, 07/16/2023 88 Years War or Dates 1961-1962 H Place of Death Hospital,Institution or WCity,Town or Village Granville Town Street Address 584 New Boston Road,Granville Town,New York 12837 p Manner of Death El Natural Cause nAccident I (Homicide Suicide nUndetermined ❑Pending IllC.) Circumstances Investigation W Medical Certifier Name Title C1 W Day PA Address 79 North Street,Granville Town,New York 12832 Death Certificate Filed Town Of Granville District Number Register Number City,Town or Village 5756 41 RBurial Date Cemetery,Crematory or Facility Name 07/18/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Date Place Removed ❑Removal and/or Held E- and/or N Hold Address 0 d Date Point of Cl)❑Transportation Shipment Q 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-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/18/2023 Registrar of Vital Statistics Jenny LinifaalMartelle(ElectronicalySrgned) (signature) District Number 5756 Place Town Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH ,, 4......... W Date of Disposition 1 7e, I t3 Place of Disposition t. (address) W NII (section) A (lot number) (grave number) o Name of Sexton or Person in Charge P raises n ie riot/ vvl ( P Ui I W ICY Signature Title DOH-1.555(o7/18)p 1 of 2 i 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#