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Gage, Kathy Christine 1- —735— NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathy Christine Gage Female Date of Death Age If Veteran of U.S.Armed Forces, 09/08/2023 69 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Hartford Town Street Address 5549 County Route 30, Hartford Town,New York 12838 p Manner of Death Z Natural Cause Accident Homicide []Suicide FlUndetermined Pending lL C.) Circumstances Investigation WG Medical Certifier Name Title Jean Hams-Letts MD Address 278 Vermont Route 149,Pawlet,Vermont 05775 Death Certificate Filed Town Of Hartford District Number Register Number City,Town or Village 5759 9 ElBurial Date Cemetery,Crematory or Facility Name 09/12/2023 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation OZ❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 tl Date Point of U) Transportation 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-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above g Address CC CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/12/2023 Registrar of Vital Statistics Denire Petteys kctronicaLySigned) (signature) District Number 5759 Place Town Of Hartford I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H W Date of Disposition 111343 Place of Disposition F�,� 4 2 (address) W CC CC (section) t number) - (grave number) 0 Name of Sexton or Person in Charge of Pre ' '� N Z (please rint) /� W Signature Title ` DOH-1555(o7/18)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#