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Hutchinson, MaryAnn LOF i:t. 6 I NEW YORK STATE DEPARTMENT OF HEALTH burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex MaryAnn Hutchinson Female Date of Death Age If Veteran of U.S.Armed Forces, 01/16/2024 87 Years War or Dates F.. Place of Death Hospital,Institution or Z City,Town or Village South Glens Falls Village Street Address 35 Harrison Avenue,South Glens Falls Village,New York 12866 WW Manner of Death Natural Cause Accident El Homicide Duicide FlUndetermined ❑Pending C.) Circumstances Investigation LU Medical Certifier Name Title CI Robert Love MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Village Of South Glens Falls District Number Register Number City,Town or Village 4524 02 RBurial Date Cemetery,Crematory or Facility Name 01/17/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 CL Date Point of Cl)❑Transportation (3by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 H Remains are Shipped,If Other than Above N Address Iz 111 a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/17/2024 Registrar of Vital Statistics Samantha Berg(ECectronica1tySigned) (signature) District Number 4524 Place Village Of South Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition I I1 17 tit Place of Disposition -1 i,r,v I, ,_) CPfzr AqW( 2 (address) III NIX (section) "2 (lot nu (grave number) 0 Name of Sexton or Person in Charge of Premises T l Z (please print) W Signature Title fl *the 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#