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Parker, Edward Harry Sr. liaC:F..)**,, 41/2_ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edward Harry Parker Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 01/15/2024 71 Years War or Dates 1971-1975 H Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address 20 Patterson Road, Fort Edward Town, New York 12828 111 Manner of Death Z Natural Cause EAccident Homicide Suicide Undetermined Pending U Circumstances Investigation ui Medical Certifier Name Title 0 David Foote MD Address 340A Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 5 Burial Date Cemetery,Crematory or Facility Name 01/17/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address U) 0 a Date Point of U)❑Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address 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 1— Remains are Shipped,If Other than Above a Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/17/2024 Registrar of Vital Statistics Aimee L Mahoney(E(ectronica((y Signed) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition I/i g 121 Place of Disposition F1 ,Zf) f W,1TV e,-y,._,. W 2 (address) 111 U)CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pre -y c s An y L y►H Z Z (pleOse print) W Signature Title G 17.F.A14'N DOH-1555 07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on s , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#—