Kilburn, Alanna NEW YORK STATE DEPARTMENT OF HEALTH _
Vital Records Section Burial Transit Permit �L
Name First Middle Last Sex
ALANNA KILBURN FETAL
Date of Death Age If Veteran of U.S.Armed Forces,
09/21/2023 FETAL War or Dates
- Place of Death Hospital, Institution
2 City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
cManner of Death 0 Natural Undetermined Pending
W (FETAL) Cause ❑ Accident El Homicide El Suicide ❑ Circumstances ❑ Investigation
LL Medical Certifier Name Title
0 THOMAS CACCIOLA MD
Address
43 New Scotland Ave., Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 FETAL
Date Cemetery or Crematory
❑ Burial 09/27/2023 PINE VIEW CREMATORY
0 Entombment Address
® Cremation QUEENSBURY, NY 12804
Date Place Removed
Removal and/or Held
El and/or
Hold Address
Date Point of
EL Transportation Shipment
V7 ❑ By Common p Carrier Destination
ID Disinterment
Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home M.B. KILMER FUNERAL HOME 01078
Address
136 MAIN STREET. SO. GLENS FALLS, NY 12803
Name of Funeral Firm Making Disposition or to Whom
} Remains are Shipped, If Other than Above
Address
1
Permission is hereby granted to dispose of the human remains described above as indicated.
1 09/27/2023
Date Registrar of Vital Statistics
Issued ____________4:::2.------
(signature)
District Number 101 Place City of Albany, NY
,
I certify that the remains of the decedent identified above were disposed of in accordance with this permiittjon:
Z Date of Disposition 'J/7g/73 Place of Disposition _ ���- f'�—
W (address)
E
w
0co
(section) (lot number) (grave number)
0
W Name of Sexton or Person in Charge of Premises /1-.11,1—
i41
/ — ase print)
Signature Title
(OVER) DOH-1555 (02/2004)
17 22
j
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
�..
Pine View Cemetery Representing the funeral home named on burial pelmit
Official Funeral Directors Reg.or License# —i