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Deimel, Majorie Anne N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marjorie Anne Deimel Female Date of Death Age If Veteran of U.S.Armed Forces, 01/01/2024 74 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Kingsbury Town Street Address 437 Town Line Road, Kingsbury Town, New York 12828 tL• Manner of Death Undetermined Pendin Natural Cause Accident Homicide Suicide g W Circumstances Investigation W Medical Certifier Name Title Sean Campanie NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Kingsbury District Number Register Number City,Town or Village 5762 1 Burial Date Cemetery,Crematory or Facility Name 01/02/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held - Hold Address 0 d Date Point of N Transportation Q by Common Shipment Carrier Destination Date Cemetery Address Disinterment 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 i— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/02/2024 Registrar of Vital Statistics Cynthia Bariin(ECectronical(ySigned) (signature) District Number 5762 Place Town Of Kingsbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: }- 2 Date of Disposition 115174 Place of Disposition (('F 2 (address) W CC CC (section) (lot number) (grave number) O Name of Sexton or Person in Charge of ises rV. ` ` O please print) Z / W ` MAI Ig Signature Title DOH-1555(07/18)p 1 of 2 I 1, 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#