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Joiner, Pauline Ann
/)7. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Pauline Ann Joiner Female Date of Death Age If Veteran of U.S.Armed Forces, 01/08/2024 77 Years War or Dates i_ Place of Death Hospital,Institution or W City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare W Manner of Death []Natural Cause []Accident Homicide []Suicide []Undetermined Pending U f ' f 1Circumstances Investigation W Medical Certifier Name Title O Brandii Baker 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 3 EBurial Date Cemetery,Crematory or Facility Name 01/10/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held l— Hold Address N 0 d Date Point of Cl)❑Transportation CI Common Shipment Carrier Destination []Disinterment Date Cemetery Address EI 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 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/10/2024 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed) (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: I— IL W Date of Disposition I/)l i 21 Place of Disposition 5V154464.4 II*► e- 2 (address) W ��,,,�_ N (section) d llot num�r/ C�1''""`� (grave number) QgName of Sexton or Person in Charge of Premises Z (ple a print) W Signature Title DOH-1555(o7/i8)p 1 of 2 alga 7 (83F _ � 'aJ' 4.i� ve.�• 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#