Loading...
Lundgren, Virginia Theresa NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Virginia Theresa Lundgren Female Date of Death Age If Veteran of U.S.Armed Forces, 12/06/2023 87 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare W Manner of Death g � �NaturalCause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Nicole Humiston NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 58 • Burial Date Cemetery,Crematory or Facility Name 12/08/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZZ Removal Date Place Removed and/or and/or Held H Hold Address 0 a Date Point of • Transportation Shipment p by Common 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 1— Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/07/2023 Registrar of Vital Statistics SheCCey Mckernon(ECectronicaCCySigned) (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: ~ !`� W Date of Disposition jZ 9zoa� Place of Disposition �,,,e I✓c euv t��rn 4 (address) W N (section1 (lot nu ber) (grave number) 0 i • Name of Sexton or Person in Charge of Pre ' es �,z_ D 5 � i (please print) 4- W Signature Title (9� 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#