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Trackey, Jona Helen NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jona Helen Trackey Female t Date of Death Age If Veteran of U.S.Armed Forces, 04/19/2020 91 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre Mannerof Death © Natural Cause Accident Homicide Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Villa a Queensbury 75657 74 X❑Burial Date Cemetery,Crematory or Facility Name 04/22/2020 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation Z Date Place Removed 0 �Removal and/or and/or Held ~ Hold Address Q a Date Point of W Transportation 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-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition orto Whom Remains are Shipped,If Other than Above Address rr a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/21/2020 Registrar of Vital Statistics Caroline 96(degarde Barber(ECectronicaCfySigned) (signature! District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition Place of Disposition (address) W U (section/ (lot number) (grave number) CName of Sexton or Person in Charge of Premises (please print) Z W Signature Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 10380 0 $Q Receipt J Human remains of deliver4d on ,1 20 �'< , \._ Pine View Cemetry Representing the funeral home named.on burial permit Official - Funeral Directors Reg.or License i TRACKEY NAME JONA HELEN TRACKEY Age:91 Lot Owner: HELEN M. DIETZE Lot# Grave# 26B UNADILLA EXT. 4 Case: CONCRETE Died: Interred: 4/19/2020 4/22/2020 Funeral Home: M.B. KILMER Cemetery: PINE VIEW CEMEIrERY