LaFarr, Marguerite Ann Zoc
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Marguerite Ann LaFarr Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/28/2022 86 Years War or Dates
f., Place of Death Hospital,Institution or
W City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
p Manner of Death El Natural Cause 0 Accident []Homicide 0 Suicide nUndetermined 1-1
Pending
W
C.) Circumstances I 'Investigation
W Medical Certifier Name Title
O Carrie Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 19
RBurial Date Cemetery,Crematory or Facility Name
03/07/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
Date Place Removed
❑Removal and/or Held
H and/or
CA
Hold Address
0
Date Point of
Cl)❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
EReinterment
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
5 Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/01/2022 Registrar of Vital Statistics Aimee L Mahoney(ECectronicaCCy Signed)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
l- F.....0(WDate of Disposition 3h i ZZ Place of Disposition (t._ �_
W
CC (section) (tot number) (grave number)
CC
/g f-).k
Name of Sexton or Person in Charge of Pr mises (pt se print) /' �,p y�
LU . C� G�.✓ig"b11
W Signature Title
DO H-1555 07/18)pi of 2
e
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#