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Stockwell, Karen Sue 45) 3y NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Karen Sue Stockwell Female Date of Death Age If Veteran of U.S.Armed Forces, 01/04/2024 67 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death ❑ ❑Undetermined �Pendin r0 Natural Cause Accident Homicide Suicide g W Circumstances Investigation U W Medical Certifier Name Title CI Asim Chaudry 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 11 Burial Date Cemetery,Crematory or Facility Name mmi 01/09/2024 Pine View Crematory - Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address 0 a Date Point of Cl)OTransportation p by Common Shipment Carrier Destination Disinterment 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 2 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/08/2024 Registrar of Vital Statistics Megan Noin(ECectronicafrySigned) (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: Z Date of Disposition 1110124 Place of Disposition 71,1/41.f. C sty '(/k.- LLI 2 (address) W NCC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises (/ease print) W Signature "" Title COI fnF.( DOH-1555(07/18)p 1 of 2 z 3 4 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the'funeral home named pn burial permit Official Funeral Directors Reg.or License#