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Fowler, Betty Joyce ATj j 441 tip) NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Betty Joyce Fowler Female Date of Death Age If Veteran of U.S.Armed Forces, 11/05/2023 91 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Argyle Town Street Address 196 West Road,Argyle Town, New York 12809 p Manner of Death ri Natural Cause []Accident 0 Homicide Suicide []Undetermined 1-1 PendingIll I ' C.) l 'Investigation Investigation LU Medical Certifier Name Title 0 Gerard Abess MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 55 Burial Date Cemetery,Crematory or Facility Name 1 1/1 112023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ElDonation Z❑Removal Date Place Removed and/or and/or Held h- Hold Address N 0 d Date Point of U)❑Transportation 8- by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address E Reinterment 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 W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/08/2023 Registrar of Vital Statistics Slrelley314ernon(Electronkaf Signed) (signature) District Number 5750 Place Town Of Argyle I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: lI— W Date of Disposition )' I)) 13 Place of Disposition �� �� C �AZ _ W (address) U) CC (section) / /lot number) `�� (grave number) 0 Name of Sexton or Person in Charge o emises 6// o✓ n Z �� (pleas print) W Signature Title (KIM Vi Tie DOH-1555(07/18)p 1 of 2 ,..t 1 7 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 11� Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#