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Renaud, Grace Elizabeth it Z_ NEWYORKSTATEDEPARTMENTOFHEALTH (Lf)Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Grace Elizabeth Renaud Female Date of Death Age If Veteran of U.S.Armed Forces, 12/30/2023 78 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 111 • Manner of Death IZ Natural Cause Accident El Homicide Suicide FlUndetermined ❑Pending W C.) Circumstances Investigation CI Medical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 619 Burial Date Cemetery,Crematory or Facility Name 01/03/2024 Pine View Crematory - Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal0 Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of N❑Transportation p by Common Shipment Carrier Destination ElDisinterment 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 �.. Retains 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 01/02/2024 Registrar of Vital Statistics Megan Wolin(ECectronicaCCySigned) (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: W Date of Disposition /15171 Place of Disposition ' rrt vr�v ( mq 2 (address) W CC CC (section) (lot number) (grave number) O Name of Sexton or Person in Charge Premises n+�ltt\ ft ease print/ Z (f� W Signature Title DOH-1555(07/18)p 1 of 2 �a -> ..f + 81..2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 ' 414 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#