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Grabowski, Janet Jessica NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Janet Jessica Grabowski Female Date of Death Age If Veteran of U.S.Armed Forces, 03/10/2024 58 Years War or Dates ZPlace of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 22 Algonquin Drive, Queensbury Town, New York 12804 p Manner of Death E Natural Cause EAccident Li Homicide IZ Suicide ❑Undetermined ❑Pending IJJ C.) Circumstances Investigation al Medical Certifier Name Title Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls, New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 41 Burial Date Cemetery,Crematory or Facility Name 03/16/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0 u Removal Date Place Removed H and/or and/or Held N Hold Address 0 a Date Point of Cl)❑Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address ElReinterment 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 H 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 03/12/2024 Registrar of Vital Statistics Caroline 9fildegarde Barber(Electronically Signed) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W ,vy Date of Disposition '1l$IZti Place of Disposition riF:-J (k' ,r"ATo 2 (address) W N Et (section) (lot number/ (grave number) 0 Name of Sexton or Person in Charge of Premises 6 r•..�1.._. ai //i Z ) (plea le print) W Signature �,� • Title ilk nA aft: DOH-1555(07/18)pi 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#