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Harvey, Roseann . LUF ..if gC11 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex RoseAnn Harvey Female Date of Death Age If Veteran of U.S.Armed Forces, 11/05/2023 91 Years War or Dates 1.., Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing W VCiManner of Death EllNatural Cause Accident ri Homicide Suicide Undetermined n Pending Circumstances II ''Investigation W Medical Certifier Name Title CI Wendy Steinhacker PA Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 169 Burial Date Cemetery,Crematory or Facility Name 11/07/2023 Pine View Crematory Entombment Address ©Cremation Queensbury-Town New York— Donation z❑Removal Date Place Removed and/or and/or Held f- Hold Address N 0 O. Date Point of V)OTransportation p by Common Shipment Carrier Destination Ei Disinterment Date Cemetery Address Date Cemetery Address E Reinterment 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 1— Remains are Shipped,If Other than Above Address It W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/07/2023 Registrar of Vital Statistics Carolinexkkgard Bar6er(Ekctronicall:y 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 is J 1t3 Place of Disposition ' ' t.) CP61.10 PM6/ih 2 (address) W NCt (section) (lot number (grave number) 0 Name of Sexton or Person in Charge of Pre ises �'' � OnnaN Z please print) Title W Signature Title AN DOH-1555(07/18)p 1 of 2 1765E Public Health Law Sec. 4145(2b) Receipt Human remains of ROSt gib 1Af2 vo delivered on /I-1 , 20 Z) Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#