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McDonnell, Lillian Josphine
tt N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records - t / u Name First Middle Last Sex l Lillian Josephine McDonnell Female Date of Death Age If Veteran of U.S.Armed Forces, 10/19/2020 95 Years War or Dates F- Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre CI Manner of Death © Natural Cause 0 Accident Homicide Suicide 0 Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title Michael Miles MD Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 196 11 Burial Date Cemetery,Crematory or Facility Name 10/21/2020 Pine View Crematory n Entombment Address 0 Cremation Queensbury Town,New York Donation (7:4 Removal Date Place Removed and/or and/or Held N Hold Address 0 0- 1-1 Date Point of Cl) ❑Transportation 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 or to Whom F. Remains are Shipped,If Other than Above 2 Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/21/2020 Registrar of Vital Statistics Caroline J(i((egarde Barber(ECectronica((ySigned) (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 Date of Disposition /01 Z317, Place of Disposition FJ/4— W (address) W Ce (section) At number) (grave number) Name of Sexton or Person in Charge of Pr ises (p/easia 1-' print) W Signature Title � t"� DOH-1555(07/t8)p 1 of 2 Public Health Law Sec. 4145(2b) - 0141.36 Receipt Human remains of delivered on , 20 a .. . Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#