Freiberger, Kecia Lee 1 IV, 4 117
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kecia Lee Freiberger Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/10/2022 57 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address 65 County Route 43,Argyle Town, New York 12809
p Manner of Death a Natural Cause []Accident []Homicide ESuicide []Undetermined ri Pending
W U f ICircumstances Investigation
W Medical Certifier Name Title
W Agee!Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 65
lillBurial Date Cemetery,Crematory or Facility Name
2022 Entombment Address12/13/ Pine View Crematory
[]Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
a. Date Point of
f)[]Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
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
N Address
CC
W
EL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/12/2022 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— ;t- L(11-- /4_____
W Date of Disposition (7 113177 Place of Disposition (address)
W
Cl) (section/ 7j (totrnumbe (grave number/
CC �A A ft
0 Name of Sexton or Person in C r of Premises (p/ eprint)
U.1
/ Title ` M�
Signature /'
7/
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#