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Kilroy, Marilyn Gail NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marilyn Gail Kilroy Female Date of Death Age If Veteran of U.S.Armed Forces, 04/26/2020 81 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Rockville Centre Village Street Address The Grand Pavilion For Rehab&Nursing At Rockville Centre Manner of Death © Natural Cause Accident 1:1Homicide 1:1Suicide ❑Undetermined Pending Circumstances Investigation Medical Certifier Name Title Olusegun Ogunfowora MD Address 41 Maine Ave,Rockville Centre Village,New York 11570 Death Certificate Filed District Number Register Number City,Town or Village Rockville Centre 2909 523 r Burial Date Cemetery,Crematory or Facility Name 05/03/2020 Pine View Crematory Entombment Address rCremation Queensbury,New York Donation Removal Date Place Removed and/or and/or Held Hold Address Transportation Date Point of by Common Shipment Carrier Destination Ej Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home NEW LEAF CREMATION 02058 Address 3930 LONG BEACH RD.,ISLAND PARK, New York 11558 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/04/2020 Registrarof Vital Statistics Kristen-Lyn 1(uteCa(L-'.CectronicaCCySigned) (signature) District Number 2909 Place Rockville Centre, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition S—�9 Zozy Place of Disposition ; '4e C cc (address (section/ (lot number) (grave number) Name of Sexton or Person in Charge A Premises �� ©•� ��� / (please print) Signature de Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#