Sanders, Sandra Lee NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Sandra Lee Sanders Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/19/2023 67 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 123 Lamplighter Acres, Moreau Town, New York 12828
nU Pending
W Manner of Death Natural Cause EAccident Homicide Suicide ndetermined �l l g
Circumstances Investigation
W Medical Certifier Name Title
O John Stoutenburg MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Moreau District Number Register Number
City,Town or Village 4562 LIS
Burial Date Cemetery,Crematory or Facility Name
08/23/2023 Pine View Crematory
_Entombment Address
Cremation Queensbury Town,New York
Donation
• Removal Date Place Removed
and/or and/or Held
F- Hold Address
CO
O
Date Point of
Cl) Transportation
Q by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
Reinterment
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
H Remains are Shipped,If Other than Above
a Address
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/22/2023 Registrar of Vital Statistics Brenda Jfutter(ECectronicaCCySigned)
(signature)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�- 1 v � --,
Z Date of Disposition g� b �Z3 Place of Disposition �
tJJ (address)
W
CC (section) /f (lotoumber) (grave number)
aName of Sexton or Person in Charge of Premises `/1J �'
Z ~(p'ase print)
Signature Title r F/hJ
errOL
DOH-1555(07/18)p 1 of 2
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#