Loading...
MacNaughton, Mary Town of Queensbury 01111" Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Mary MacNaughton were cremated on February , 10 20 22 at the Pine View (Month) (Day) Crematorium, Queensbury, New York, and these are the cremated remains of said body. Date of Death February , 6 20 22 Age 92 (Month) (Day) Funeral Home M.B. Kilmer Registered No. 129 (Authori d Sig:lure) MacNaughton NAME Mary MacNaughton Age: 92 Lot Owner: James MacNaughton Lot# Unadilla EXT 32 A Grave# 5 Case: Urn Died: 2.6.2 2 Interred: 6.2.2 2 Funeral Home: M.B. Kilmer Cemetery: Pine View NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary Elizabeth MacNaughton Female Date of Death Age If Veteran of U.S.Armed Forces, 02/06/2022 92 Years War or Dates F— Place of Death Hospital,Institution or z City,Town or Village Albany Street Address Daughters Of Sarah Nursing Center Manner of Death © W Natural Cause Accident Homicide Suicide Undetermined El Pending U Circumstances Investigation O Medical Certifier Name Title Marianne Mustafa MD Address 180 Washington Ext Ave,Albany, New York 12203 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 0387 Burial Date Cemetery,Crematory or Facility Name 02/10/2022 Pine View Crematory Ei Entombment Address lCremation Queensbury Town,New York ElDonation O CIRemoval Date Place Removed and/or and/or Held F— Hold Address 0 0- Date Point of U) ❑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-South Glens Falls 01078 Address 136 Main St,S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2022 Registrar of Vital Statistics DanieCCeS Cirrespie( (ectronicaCfySigned) (signature) District Number 0101 Place Albany, 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 C4—�7— Place of Disposition �� VIA Ctc p,1,W 2 (address) W CC (section) (lot number) (grave number) ciName of Sexton or Person in Charge of Premises fie,( m Z (please print) W Signature /7/./. Title CD.,/n G(" DOH-1555(07/18)p t of 2 .- 1 a'#R 1, 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#