Manninen, Mary Jean # lzl
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mary Jean Manninen Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/01/2023 84 Years War or Dates
1.. Place of Death Hospital,Institution or
WCity,Town or Village Easton Town Street Address 242 Cloister Way,Easton Town,New York 12834
p Manner of Death E Natural Cause Accident 0 Homicide []Suicide Undetermined ❑Pending
W
V Circumstances Investigation
Q Medical Certifier Name Title
Kristen Kelley DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Easton District Number Register Number
City,Town or Village 5753 1
Burial Entombment Date Cemetery,Crematory or Facility Name
02/03/2023
Address Pine View Crematory
--
EICremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
F= and/or and/or Held
N Hold Address
0
O. 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-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped,If Other than Above
M Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/03/2023 Registrar of Vital Statistics ✓NleglatrQ1'Fralen(' ctronicallySrgned)
(signature)
District Number 5753 Place Town Of Easton
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /`�
I—
W Date of Disposition Z 23 Place of Disposition
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2 (address) v—
W
U)
CC (section) // (lot number) C (grave number)
GName of Sexton or Person in Charge of Premises + ?� E}
Z lease print/
W Signature Za-- Title s
DOH-1555(07/18)p 1 of 2
i
I Public Health Law Sec. 4145(2b)
1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#