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Richards, Kelly Elizabeth 01 :11 NEW YORK STATE DEPARTMENT OF HEALTH �- s31 Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kelly Elizabeth Richards Female Date of Death Age If Veteran of U.S.Armed Forces, 06/27/2023 61 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address 404 Goodman Road,Johnsburg Town,New York 12843 UJ p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title O Kyle Leonard MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 22 Burial Date Cemetery,Crematory or Facility Name 06/29/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address 0 0. Date Point of Cl) Transportation p by Common Shipment Carrier Destination 111 Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above S Address KC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/29/2023 Registrar of Vital Statistics ,lean M Comstock(E(ectronically Signed) (signature) District Number 5655 Place Town Of Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z Date of Disposition (c/30I7.s Place of Disposition nd/ 11J (adUressJ 2 W N CC (section) (lot number) (grave number) � gName of Sexton or Person in Charge of P miles /„rk�� (p/e a print/ / W terSignature Title ` m� DOH-1555(07/18)p 1 of 2 Public Health Health Law Sec. 4145(2b) Receipt Human remains of 1 delivered on ' , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# j