Hill, Tracey Lynn s 1 I QV
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Tracey Lynn Hill Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/18/2021 49 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
W Undetermined Pending
W Manner of Death El NaturalCause �Accident El Homicide �Suicide
Circumstances Investigation
W Medical Certifier Name Title
0 Sarah McMahon PA
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 0556
12 Burial Date Cemetery,Crematory or Facility Name
02/20/2021 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
ElDonation
t 0 Removal Date Place Removed
and/or and/or Held
Hold Address
N
0
O. Date Point of
Cl) LiTransportation
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
1- Address
CC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/19/2021 Registrar of Vital Statistics Dania&Scarpie( ctronica/CySigned)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F— �7
Z Date of Disposition a.a(1_ ), Place of Disposition Pi AL /je . ()pox,'4 Iv rq
2 (address,)
W
to
rave number)
CC (section) ) (lot number) g
• Name of Sexton or Person in Cha e of PremiseA�(Mv,�4 �• L(,
(please print)
Z
W Signature Title oT ervie,r
DOH-1555(o7/18)p i of 2 V
Public Health Law Sec. 4145(2b) ,4 ';
Receipt
Human remains of • ., , �\ delivered on , 20 '_,
Pine View Cemetery Representing'the funeral home named on burial permit
Official Funeral Directors Reg.or License#