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Facto, Krista Elizabeth
e , 1, 4- 2 17 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Krista Elizabeth Facto Female Date of Death Age If Veteran of U.S.Armed Forces, 03/15/2022 39 Years War or Dates l` Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address Sumpter NW Street,Hudson Falls Village,New York 12839 W O Manner of Death El Natural Cause Accident III Homicide nSuicide Undetermined ❑Pending al 0 Circumstances Investigation W Medical Certifier Name Title O Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Village QJ Hudson Falls District Number Register Number City,Town or Village 5726 15 FDateBurial Cemetery,Crematory or Facility Name 03/18/2022 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F- o Hld Address N 0 Q. Date Point of b)ElTransportation p by Common Shipment Carrier Destination Ei Disinterment Date Cemetery Address III 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 W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/17/2022 Registrar of Vital Statistics Cynthia A Bardin(Electronically Signed) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition 3 ,_Z©ic Place of Disposition ��„) �'; ,J L'r— j,t-�A ,2 (address) W CCCC (section) (lot number) (grave number) g rq�/r1 ll(/• Name of Sexton or Person in Charge of Premises o, Z �� (please print) W Signature 1 Title QP�Tu •� DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#