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Beaty, Monica Marie Nikk (SO NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Monica Marie Beaty Female Date of Death Age If Veteran of U.S.Armed Forces, 09/27/2023 89 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI pI I Manner of Death Natural Cause Accident ❑Homicide Suicide Undetermined ❑Pending C.) 1 Circumstances Investigation W Medical Certifier Name Title O Bo Li MD Address 100 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 446 Burial Date Cemetery,Crematory or Facility Name 09/28/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held ~ Hold Address U) 0 CL Date Point of Cl)❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address nDisinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom f.. Remains are Shipped,If Other than Above N Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/28/2023 Registrar of Vital Statistics Megan Nolin(Electronicall5 Signer9 (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— � Z Date of Disposition 11241 to Place of Disposition -Prufriir (e,r rniZrak-- 111 2 (address) W t/) CC (section) (!ot number/ (grave number) 0 Name of Sexton or Person in Charge of Pr ises �r.f.._- ,...I Z (plrint) W Signature Title rr.46111Yl fl'j DOH-1555(07/18)p 1 of 2 I 0 tj I Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 . t4 Pine View Cemetery ' Representing the funeral home named on,burialyrtit Official Funeral Directors Reg.or License#