Davie, Kathleen Mary NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kathleen Mary Davie Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/01/2020 92 Years War or Dates
F.. Place of Death Hospital,Institution or
WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
`p Mannerof Death ❑X Natural Cause ❑Accident Homicide ❑Suicide Undetermined Pending
V Circumstances Investigation
W Medical Certifier Name Title
Michael Miles MD
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed District Number Register Number
City,Town or Village Fort Edward 5755 1
Burial Date Cemetery,Crematory or Facility Name
01/03/2020 Pine View Crematory
Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
OZ ❑Removal Date Place Removed
and/or and/or Held
V)N Hold Address
O
IL Date Point of
U) ❑Transportation
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
F Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/03/2020 Registrar of Vital Statistics 4,nzee MaAoney(Ekrtro--affy Sy=4
(signature)
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 113170 Place of Disposition Ed'
W (address)
W
Ncc (section) (lot number), (grave number)
8 Name of Sexton or Person in C rge of PremisAII.L
Z ease print
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013196
Receipt
Haman remains of `,: delivered on # , 20
, a
Pine View Cemetery Representing the funeral home named n b rial permit
Official Funeral Directors Reg.or License# '1
, r