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Semanscin, Margaret Ann
1 it 11os NEW YORK STATE DEPARTMENT OF H EALTH 4 Burial - Transit Permit Bureau of Vital Records A • Name First Middle / Last Sex Margaret Ann Semanscin Female Date of Death Age If Veteran of U.S.Armed Forces, 12/10/2021 79 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Hartford Town Street Address 71 Old Town Way,Hartford Town,New York 12838 p Manner of Death © Natural Cause ❑Accident ❑Homicide 1=1 Suicide El Undetermined 0 Pending W U Circumstances Investigation W Medical Certifier Name Title CI Wesley Perry Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Hartford 5759 9 ElBurial Date Cemetery,Crematory or Facility Name 12/23/2021 Pine View Crematory ElEntombment Address 0 Cremation Queensbury Town,New York ElDonation Z Date Place Removed Removal and/or Held I— and/or N Hold Address 0 CL 1-1 Date Point of U) Li Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address Reinterment 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 H Remains are Shipped,If Other than Above N Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/20/2021 Registrar of Vital Statistics rDenise'Petteys(ECectronica[TySigned) (signature) District Number 5759 Place Hartford, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— W Date of Disposition )2123 iii Place of Disposition r.•�•U`.__ 4dr-- address) W N (section) (lot number) (grave number) CC Name of Sexton or Person in Charge f Premises Al �--- 11 MIf Z (pi se print/W Signature ___� Title CriS,�+1�e DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#