Loading...
Swinton, Melanie Carole zz NEW YORK STATE DEPARTMENT OF HEALTH r t Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Melanie Carole Swinton Female Date of Death Age If Veteran of U.S.Armed Forces, 01/04/2021 74 Years War or Dates ,.„, Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 1681 Bay Road,Queensbury Town,New York 12845 p Manner of Death © Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title Amy Hogan-Moulton MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 5 ❑Burial Date Cemetery,Crematory or Facility Name 01/07/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York Donation Q Date Place Removed ❑Removal and/or and/or Held tl� Hold Address 0 a Date Point of to Li Transportation Q by Common Shipment Carrier Destination ElDisinterment 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 p.- Remains are Shipped,If Other than Above g Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/06/2021 Registrar of Vital Statistics Caroline.7fi1degarde(Barber(ECectronicaltySigned) (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: H � Z Date of Disposition I /g/71 Place of Dispositionatedress) W CC (section) (lo umber) (grave number) GName of Sexton or Person in Charge of Pre ises �' L )YHA 1�f (please prin) Z W Signature Title 117044 IV DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) 0 4 386 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#