VanWinkle Megan Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Megan Elizabeth Van Winkle Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/18/2020 18 Years War or Dates
Place of Death Hospital,Institution or ,
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Undetermined Pending
Natural Cause �Accident �Homicide �Suicide
Circumstances Investigation
Medical Certifier Name Title
0 Timothy Murphy Coroner
Address
52 HAVILAND AVE,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 22
®Burial Date Cemetery,Crematory or Facility Name
02/27/2020 Pine View Cemetery
Entombment Address
Cremation Queensbury Town,New York
Donation
'Z Removal Date Place Removed
and/or and/or Held
~ Hold Address
tt!
Date Point of
Transportation Shipment
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-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
E Remains are Shipped,If Other than Above
Address
W
Q` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/24/2020 Registrar of Vital Statistics Robert Andrew('urtis(ZCectronicaffy,Signed)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1- 4� Date of Disposition 2/2 7/2 0 2R1ace of Disposition Pine View 21 Quarker Rd. Queensbur
Z (address)
iW Erie 4 sp
rave number/
(section) )lot number)
Name of Sexton or Person in Charge of Premise g
S Connie Goedert
/Pteasep int)
Z
Signature Titl
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 010369
Receipt
Human remains of ? delivered on_ - , 20—- (
Fine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# —
VANWINKLE
Owner
Address Plot
9 Peggy Ann Rd Oueenshury NY 12ROA Erie
Phone # Lot #
45D
Deed # Date
4161 2/27/2020
Cost Foundation Y - N
$650 00
Location NORTH- Palmer
SOUTH- Vacant
EAST- Vacant
WEST- Wicks
Remarks
Record of Interments
1 6
Megan VanWinkle 2y 1 9T2A,2^
2 /
3 8
4 9
5 10
V �
4 �
he
� R
E
IANWINKLE
NAME Megan VanWinkle Age: 18
Lot Owner: Megan VanWinkle
Lot# 45D Erie Grave# 1
Case: Concrete
Died: 2/1 8/2 0 2 0 Interred:
2/27/2020
Funeral Home: M.B. Kilmer
Cemetery: Pine View