Guilder, Elwaine Jay - -LOF J:t--
NEW YORK STATE DEPARTMENT OF HEALTH it
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Elwaine Jay Guilder Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/18/2024 78 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address 318 Coot Hill Road,Argyle Town, New York 12809
III
p Manner of Death IT Natural Cause Accident ❑Homicide Suicide Undetermined Pending
W Circumstances Illnvestigation
W Medical Certifier Name Title
0 Robert Lemieux Coroner
Address
415 Lower Main Street,Hudson Falls Village, New York 12839 1
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 20 il
Burial Date Cemetery,Crematory or Facility Name
03/25/2024 Pine View Crematory
Entombment Address
nCremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
Eland/or and/or Held
F- Hold Address
U)
0
Q. Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
El
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
N Address
IE
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/22/2024 Registrar of Vital Statistics SlielleyMckfrrrata(EYectronicagy,SOceti)
(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:
Ii—
WDate of Disposition 3)75-12 Place of Disposition ; y �4 ,Z�„`
y ( (address)
7Va
W
Q (section) f (lot number) (grave number)
Name of Sexton or Person in Charge f P mises r, sLI Ili
`Z 66 tease print) �^
Signature Title [ / '1�n
4,
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0
Receipt
Human remains of delivered on , 20
••• View Cemetery Representing the funeral home named on burial permit
Funeral Directors Reg. or License#