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Breen, Margaret Elizabeth NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margaret Elizabeth Breen Female Date of Death Age If Veteran of U.S.Armed Forces, 03/18/2021 83 Years War or Dates 2 Place of Death Hospital,Institution or City,Town or Village Moreau Town Street Address 39 Pine Valley Drive, Moreau Town,New York 12803 p Manner of Death © Natural Cause 0 Accident 1=1 Homicide ❑Suicide ❑Undetermined 0 Pending Illtl 0 Circumstances Investigation W Medical Certifier Name Title Pi Jamie Bovair NP Address 325 Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 16 ElBurial Date Cemetery,Crematory or Facility Name 03/19/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York Donation ZDi Removal Date Place Removed and/or and/or Held F. Hold Address N 0 Date Point of ❑Transportation Shipment p by Common Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address CC t[J IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/19/2021 Registrar of Vital Statistics Geeann!fc case(ctectronically Signed) (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with thisseermit on: 4,....._ W Date of Disposition 31_11 I tit Place of Disposition �..�_2 (address) Di am, (section) JLeprt umber) (grave number) GName of Sexton or Person in Charge of Premise pm S Ow411 ZZ Ill Signature / Title `1 ��I T2 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01 4.6 5 0 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#