Mandigo, Astreya Chrystie NEW YORK STATE DEPARTMENT OF HEALTH LF _
Bureau of Vital Records Burial Transit Permit
Name First Middle Last Sex
Astreya Chrystie Mandigo Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/23/2022 5 Mos.8 Days War or Dates
t,.. Place of Death Hospital,Institution or
Z City,Town or Village Kingsbury Town Street Address 2009 County 43 Route, Kingsbury Town,New York 12839
111
Q Manner of Death I I Natural Cause Accident I I Homicide Suicide Undetermined Pending
W I 0 Circumstances Investigation
W Medical Certifier Name Title
C Robert Lemieux Coroner
Address
415 Lower Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed Town Of Kingsbury District Number Register Number
City,Town or Village 5762 12
Burial Date Cemetery,Crematory or Facility Name
05/31/2022 , Pine View Crematory
❑Entombment Address
Cremation Queensbury Town,New York
Donation
Q Removal Date Place Removed
and/or and/or Held
f- Hold Address
N
0
Q. Date Point of
CO Transportation Shipment
p by Common ---
Carrier Destination
Date Cemetery Address
nDisinterment
Reinterment Date Cemetery Address
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
M Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/31/2022 Registrar of Vital Statistics Cynthia Bardin(ECectronicaCCySigned)
(signature)
District Number 5762 Place Town Of Kingsbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 14,
H L.
Z Date of Disposition G 1 1 I zz Place of Disposition ��
LU /address/
W
0 (section)
tot nuG a� Swirl-
ber) (grave number)
o Name of Sexton or Person in Charge of Premises
Z / (pl se print) /),
W Signature Cr— � ��►2
Title (°
DOH-1555(07/18)p 1 of 2
i -
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on - , 20
1
Pine View Cemetery Representing the funeral home named on burial pernut
Official Funeral Directors Reg.or License#