Loading...
Mohan, Emma Marie �33 NEWYORK STATE DEPARTMENT OF HEALTH t Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Emma Marie Mohan Female Date of Death Age If Veteran of U.S.Armed Forces, 03/11/2020 100Years War orDates Place of Death Hospital,Institution or City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending 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 Vilta a Fort Edward 5755 22 ❑Burial Date Cemetery,Crematory or Facility Name 03/12/2020 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held Hold Address iE ❑ of Transportation Date TSPI[hipment int O by Common Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address El Reinterment 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 Remains are Shipped,If Other than Above Address at W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/12/2020 Registrar of Vital Statistics Aimee Mahoney(Eiectronicady Signed) (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 3 207,0 Place of Disposition (addre W (section) (lot/number) (grave number) Name of Sexton or Person in yChaa ofPremise (pleaseprint) Signature Title DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) -11342 Receipt Human remains of delivered on , 20 J Pine View Cemetery Representing the funeral home named on burial permit ''Official Funeral Directors Reg.or License#