Loading...
Morency, kathleen4671 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last --FSex Kathleen Elizabeth Morency Female Date of Death Age If Veteran of U.S. Armed Forces, 10/23/2019 63 Years War or Dates F— Place of Death Hospital, Institution or Z City, Town or Village Saratoga Springs Street Address Saratoga Hospital pMannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Timothy Reed MD Address 211 Church St, Saratoga Springs, New York 12866 Death Certificate Filed District Number Register Number City, Town or Village Saratoga Springs 1 4501 559 Burial Date Cemetery, Crematory or Facility Name —7Pine Entombment 10/24/2019 View Crematory Address PflCremation Queensbury Town, New York Donation 0 ❑ Removal Date Place Removed and/or Held ~ and/or Hold Address N O IL Date Point of NElTransportation p 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 - Fort Edward 01079 Address 82 Broadway, Fort Edward, New York 12828 Name of Funeral Firm Making Disposition orto Whom E— Remains are Shipped, If Otherthan Above Address Q LU Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/24/2019 Registrar of Vital Statistics John Pau(Eranck(ECectronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 1011S I I Place of Disposition ,., 4ri„` W (address) W (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises lease print/ ZZW Signature Title DOH-1555 (07/18) p 1 of 2 Public Health Law Sec. 4145(2b) 013024 Receipt Human remains of k O17 elivered on 20—t� j Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License #