Howard, Kileen Jo . LF
.if —) 1 bi
._
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kileen Jo Howard Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/06/2022 67 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 139 Feeder Dam Road,Moreau Town,New York 12803
ILI
p Manner of Death EI Natural Cause Accident El Homicide lilSuicide ❑Undetermined Pending
V Circumstances Investigation
W Medical Certifier Name Title
O Jennifer Stratton MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Moreau District Number Register Number
City,Town or Village 4562 50
Burial Date Cemetery,Crematory or Facility Name
E09/08/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
g❑Removal Date Place Removed
and/or and/or Held
I Hold Address
N
0
C• Date Point of
(D❑Transportation
p by Common Shipment
Carrier Destination
nDisinterment
Date Cemetery Address
Date Cemetery Address
El Reinterment
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
g Address
CC
LU
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/08/2022 Registrar of Vital Statistics Leeann McCabe(ECectronicatTySigned)
(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:
Z Date of Disposition gi fri(2Z Place of Disposition �,,,,.L L
tu
H 1`
(address)
W
N 0 //(section) J (lot number) (grave number)
lt
0 Name of Sexton or Person in Char f Premises ! 't"
Z (p/e se print) /�,,�,, �
W Signature L/' Title "A1(l
DOH-1555(07/18)p t of 2
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#