Burke, Erin Rose t t ►�
NEW YORKSTATE DEPARTMENT OF HEALTH Burial -Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Erin Rae Burke Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/02/2020 39 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Argyle Town Street Address 11 Storey Lane,Argyle Town,New York 12809
p Mannerof Death Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
WMedical Certifier Name Title
Robert Lemieux Coroner
Address
415 Lower Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed District Number Register Number
City,Town or Village Argyle 5750 1
Burial Date Cemetery,Crematory or Facility Name
01/07/2020 Pine View Crematory
Entombment Address
K❑Cremation Queensbury Town,New York
Donation
Z Date Place Removed
FIRemoval
and/or and/or Held
I— and/or
Address
as
aDate Point of
N ❑Transportation Shipment
Q by Common
Carrier Destination
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
.. 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 01/06/2020 Registrar of Vital Statistics ShelleyMckernon(EkctronrcadSigned)
(signature)
District Number 5750 Place Argyle, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
W Date of Disposition 20 Place of Disposition M7r0 L.
(address)
W
U) (sectron) (lot number) (grave number)
O Name of Sexton or Person in Charge Premises
o (p/ se print/
W Signature Title
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) r 113 213
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#