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Brown, Kathleen M
... ,,, ,.,,.,,I,T,): 6 96, NEW YORK STATE DEPARTMENT OF HEALTH Burial -Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathleen M Brown Female Date of Death Age If Veteran of U.S.Armed Forces, 08/25/2023 60 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing ILI p Manner of Death IZ Natural Cause ❑Accident Homicide ESuicide FlUndetermined ri Pending W Circumstances Investigation 0 LU Medical Certifier Name Title 0 Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 133 Burial Date Cemetery,Crematory or Facility Name 08/29/2023 Pineview Crematory Entombment _ Address ©Cremation Queensbury Town,New York 0Donation gip Removal Date Place Removed - and/or and/or Held F—- Hold Address N 0 Date Point of fA❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above "S Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/28/2023 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 thispermit on: Z Date of Disposition g3 r 1 0z z3 Place of Disposition ..ie y i Cam/ Cr,G UJ (address) g W NCC (section) (lot number (grave number) GName of Sexton or Person in Charg of Premi s ��6 �'IP !V Z / (please print) LU Signature Title 0(V-4710 C DOH-1555(07/18)p 1 of 2 ,ry^,...._ --I I Public Health Law Sec. 4145(2b) Receipt , Human remains of " • :/' • delivered on , 20 o • • , • Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#