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Sims, Frank Lynn 4111) 14- --,,f, NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Frank Lynn Sims Male Date of Death Age If Veteran of U.S.Armed Forces, 09/02/2023 74 Years War or Dates l— Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 63 Minnesota Avenue,Queensbury Town,New York 12804 ILI p Manner of Death El Natural Cause []Accident El Homicide OSuicide nUndetermined []Pending UJ 0 Circumstances I 'Investigation LU Medical Certifier Name Title 0 Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number • City,Town or Village 5657 139 RBurial Date Cemetery,Crematory or Facility Name 09/05/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Date Place Removed 0❑Removal and/or Held I- - and/or N Hold Address 0 Date Point of to❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address ElReinterment 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 l^ Remains are Shipped,If Other than Above 2 Address Ir . W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued . 09/05/2023 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition q110 173 Place of Disposition P�, /-4- uJ (a L dress) W N (section) (lot number) (grave number) CC g Name of Sexton or Person in Char Premises "t �...- tN ase print) Z Cf � W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemtt y Representing the funeral home named on burial permit Official Funeral Directors keg.or License#