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Flynn, Gladys Marion 0 LF /Yt NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gladys Marion Flynn Female Date of Death Age If Veteran of U.S.Armed Forces, 11/21/2023 92 Years War or Dates 1_, Place of Death Hospital,Institution or WCity,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing O Manner of Death El Natural Cause Accident Homicide 0Suicide Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title CI Brandii Baker NP Address 10421 State Route 40,Granville Town,New York 12832 DeaAth Certificate Filed Town Of Granville District Number Register Number City,Town or Village 5756 69 Burial Date Cemetery,Crematory or Facility Name 11/22/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held i Hold Address 0 _.. 0- Date Point of U)❑Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address El 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 H Remains are Shipped,If Other than Above a Address CC WI a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/21/2023 Registrar of Vital Statistics Jenny Linda I[9KartelTe(E(ectronica((ySigned) (signature) District Number 5756 Place Town Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— I O Date of Disposition /�rs= g Place of Disposition ,wf( 1,4&,A) C, d-M r 2 (address) W CCCC (section) (lot number) (grave number) O Name of Sexton or Person in Charge re 'se �Ir1D«,J� tde ,e1 Z (please print) tL Signature s Title OQi?eClA DOH-1555(07/18)p 1 of 2 u c: 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#