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Morrison, Madeline Helen 111.CF... NEW YORK STATE DEPARTMENT OF H EALTH Sig Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Madeline Helen Morrison Female Date of Death Age If Veteran of U.S.Armed Forces, 07/23/2023 75 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village South Glens Falls Village Street Address 9 Circle Drive,South Glens Falls Village,New York 12803 W Manner of Death ZI Natural Cause nAccident ❑Homicide Suicide Undetermined 1-1 Pending C.) Circumstances Investigation W Medical Certifier Name Title G Robert Ball Coroner Address 6010 County Farm Road,Ballston Spa Village,New York 12020 Death Certificate Filed Village Of South Glens Falls District Number Register Number City,Town or Village 4524 16 Burial Date Cemetery,Crematory or Facility Name 07/25/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F Hold Address N 0 CL Date Point of Li) Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address 111 Reinterment Date Cemetery Address 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 2 Address LE W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/25/2023 Registrar of Vital Statistics Matthew Espey(Electronically Signed) (signature) District Number 4524 Place Village Of South Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 7/41 Z3 Place of Disposition Rah-- d r-_ W (address) W N CC (section) / (lot number) (grave number) Name of Sexton or Person in Charge of Premises ` 111 f It Z (ple se print /� lU ivx Signature L/' Title l{Q ►1Y� DOH-1555(07/18)p 1 of 2 .) 1 7 1 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#