Powers, Christina Marie . - 1,,E.:____F) # b
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Last I Sex
Middle
Name First Female
Christina Marie Powers
Date of Death Age If Veteran of U.S.Armed Forces,
08/03/2022 45 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 9 D Tangier Way,Moreau Town,New York 12828
W Manner of Death Undetermined Pending
p �NaturalCause Accident Homicide Suicide
W Circumstances Investigation
U Title
U l Medical Certifier Name
Susan Hayes-Masa Coroner
Address
40 McMaster Street,Ballston Spa Village,New York 12020
Death Certificate Filed Town Of Moreau District Number Register Number
4562 43
City,Town or Village
Burial Date Cemetery,Crematory or Facility Name
08/05/2022 Pine View Crematory
Entombment— Address
Cremation Queensbury Town,New York
Donation
z
Date Place Removed
o
CI Removal and/or Held
I-
- and/or
CD
Address
0
Date Point of
Cl)❑Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
illReinterment
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
F— Remains are Shipped,If Other than Above
2 Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/05/2022 Registrar of Vital Statistics Leeann Mc cabe(Electronically Signed)
(signature)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH /
W Date of Disposition g Ito ZZ Place of Disposition 'I�rAAV , art,
(address)
W
CC (section) (lot number) (grave number)
CC
CName of Sexton or Person in Charge of Premisespleaseprinr/
z �r24M� -
W Signature Title
DOH-1555(07/18)pi of 2
4
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#