Byrne, Margaret Lorraine NEW YORKSTATE DEPARTMENT OF HEALTH 774
Bureau - Transit Permit
of Vital Records
Name First Middle Last • Sex
Margaret Lorraine Byrne Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/14/2021 93 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Village Street Address 5 Maple Street, Fort Edward Village,New York 12828
Manner of Death I Natural Cause ❑Accident Homicide 0 Suicide ❑Undetermined Pending
W Circumstances Investigation
W MediCat trtlfier Name Title
Mary Stein NP
Address
9 Carey Koad,Queensbury Town, New York 12804
Death Certificate Filed a District Number Register Number
City,Town or Village Fort Edward 5755 36
0 Burial Date Cemetery,Crematory or Facility Name
06/16/2021 Pine View Crematory
0 Entombment -!\ddress
lCremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
F, and/or and/or Held
Hold Address
0
CL Date Point of
Cl) Li Transportation
IT) by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterrnent
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
I— Remains are Shipped,If Other than Above
•Address
t
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/15/2021 Registrar of Vital Statistics Aimee L Mahoney(6Cectronica11ySigned
(signature)
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H �
W Date of Disposition (0 ill 'Z( Place of Disposition FILL f 4—dtl�
2 (address)
W
IX (section) //(lot number) (grave number)
O Name of Sexton or Person in Charge of Pre ises `' /`1 a4'�
(pleas d print)
Signature Title OsihnirOtt,
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014864
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#