Coxon, Renee NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
1.,....41
Name First Middle Last Sex
Renee Louise Coxon Female
Date of Death Age If Veteran of,J.S. Armed Forces,
07/26/2013 31 War or Dates
Place of Death Hospital, Institution or
ZCity, Town or Village Moreau Street Address
Manner of Death Natural Cause 0 Accident n Homicide Suicide riUndetermined 0 Pending
Llt Circumstances Investigation
til Medical Certifier Name Title
0 Susan Haves-Masa Coroner
Address
579 Grand Ave, Saratoga Springs,NY 12866
Death Certificate Filed District Number i, Register umber
City, Town or Village Moreau `i020
['Burial Date Cemetery or Crematory
07/29/2013 Pineview Crematory
!i ['Entombment Address
`jl®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
❑Removal and/or Held
Address ress and/ . _.____ ___
�;
l)
Hold
Date Point of
piEl Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
<3❑Reinterment Date Cemetery Address
ifii Permit Issued to Registration Number
>; Name of Funeral Home MB Kilmer Funeral Home 01 079
Address
82 Broadway,Fort Edward,NY 12828
giiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
II
41
Permission is hereby granted to dispose of the human remains described above as indicated.
iiiiii Date Issued 7-,z q -13 Registrar of Vital Statistics ����'17'!�V(� � LL l(signature)
District Number Lf c�f'O 2_ Place b f H Ui)So& ST,, So am6'L J F9/,. t� i 7,q 3
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Ili Date of Disposition 1 A 3.^ll Place of Disposition .? .UA.j a mi+0t i
(address)
LEE
to
m (section) ` (lot number) (grave number)
CI CI Name of Sexton or Pers n in Charge o Premises ` L._ ;nt�a lease pr )
„t Signature Title C6Li,
(over)
DOH-1555 (02/2004)