Loading...
Evarts, Kathleen , 611 ,i Si I NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathleen Evarts Female Date of Death Age If Veteran of U.S.Armed Forces, 07/11/2023 64 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Hudson Falls Village Street Address 11 Coleman Avenue,Hudson Falls Village,New York 12839 p Manner of Death El Natural Cause Accident Homicide ESuicide ❑Undetermined ❑Pending W U Circumstances Investigation WI Medical Certifier Name Title William Parker MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 20 Burial Date Cemetery,Crematory or Facility Name 07/13/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York EIDonation 0❑Removal Date Place Removed H and/or and/or Held N Hold Address 0 d Date Point of U)ETransportation 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-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/12/2023 Registrar of Vital Statistics Cynthia cBardin(ECectronicadySigned) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH .---, Z Date of Disposition 7 I g 4 I l. Place of Disposition _ 7; uti 2p (address) W U) tr (section) ,(lot number) (grape number) Name of Sexton or Person in Charge of Premi I L. L ,,4 11' Z (ple print/ W Signature Title• II � ' f DOH-1555(07/18)p 1 of 2 1.:. Public Health Law Sec. 4145(2b) <: i Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ,ij,_