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Stanton, Helen Ruth NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Helen Ruth Stanton Female Date of Death Age If Veteran of U.S.Armed Forces, 09/11/2023 88 Years War or Dates .. Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 264 Main Street 7, Hudson Falls Village,New York 12839 IJJ p Manner of Death El Natural Cause Accident ❑Homicide Suicide Undetermined Pending MI 0 Circumstances Investigation WL I Medical Certifier Name Title Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Village Of Hudson Falls District Number Register Number W City,Town or Village 5726 9 Burial Date Cemetery,Crematory or Facility Name ® 09/12/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York \ Donation ZO Removal Date Place Removed and/or and/or Held i— Hold Address 0 d Date Point of Cl)❑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-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom -. Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/12/2023 Registrar of Vital Statistics Cynthia Bardin(ECectronicaffy Signed) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t &- Z Date of Disposition 9li1{11 Place of Disposition /�, address) W CO (section) hot number) (grave number) 0 Name of Sexton or Person in Charge of Premises /A1 _t +�j Z ( se print) W Signature Title 16011- 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#