Livingston, Betty Ann NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Betty Ann Livingston Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/21/2023 83 Years War or Dates
i_ Place of Death Hospital,Institution or
W City,Town or Village Whitehall Village Street Address 8 Elizabeth Street,Whitehall Village, New York 12887
p Manner of Death I I Natural Cause Accident n Homicide ESuicide Undetermined []Pending
W C.) Circumstances I I Investigation
W Medical Certifier Name Title
O Antonio Izzo NP
Address
340A Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed Town Of Whitehall District Number Register Number
City,Town or Village 5766 9
EBurial Date Cemetery,Crematory or Facility Name
04/25/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
a Date Point of
U)[]Transportation
p by Common Shipment
Carrier Destination
III
Disinterment
Date Cemetery Address
Date Cemetery Address
p Reinterment
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
Address
CC
W
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/25/2023 Registrar of Vital Statistics Patti cordon(E/ctronicalljt Sagnerl)
(signature)
District Number 5766 Place Town Of Whitehall
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition ij)Zh i13 Place of Disposition '1 14 Zfr,------
2 (address)
W
U)CC (section) (lot number) (grave number)
O Name of Sexton or Person in Charge of Premises 0)r''ML- Vvf it
Z (p ase grin f
W Signature �� Title L t‘ilY1 41-0e
DOH-1555(o7/18)p 1 of 2
I.) 1 `.
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#