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Mischko, Olga
• I2-s NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Olga Mischko Female Date of Death Age If Veteran of U.S.Armed Forces, 02/08/2022 95 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc p Manner of Death © Natural Cause Accident Homicide Suicide El UndeterminedID Pending Circumstances Investigation W Medical Certifier Name Title 0 Carrie Miron PA Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 11 ▪Burial Date Cemetery,Crematory or Facility Name 02/09/2022 Pine View Crematory ❑Entombment Address ICremation Queensbury Town,New York ▪Donation Removal Date Place Removed and/or and/or Held - Hold Address 0 0- Date Point of ❑ (I) Transportation 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 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom �-. Remains are Shipped,If Other than Above Address a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/09/2022 Registrar of Vital Statistics Aimee L Mahoney(E(ectronica(Cy Signed) (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: Z ' cr W Date of Disposition 1—�—AL Place of Disposition }�;�c) r Vi�o Ci{G/►'�i�by 2 (address) W NCC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises eshi r,rs (please print) W Signature Title C.rtm37Mr DOH-1555(07/18)p i of 2 • .0 Public Health Law Sec. 4145(2b) Receipt t Human remains of ( ' delivered on , 20 Pine View Cemetery Representing the funeral home named on buritpermit ." Official Funeral Directors Reg.or License#