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Moloney, Paul Francis Ai- 73 NEW YORK STATE DEPARTMENT OF HEALTH LF Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Paul Francis Moloney Male Date of Death Age If Veteran of U.S.Armed Forces, 09/25/2023 87 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Village Street Address 188 Broadway, Fort Edward Village,New York 12828 W Manner of Death Undetermined Pendin 0 Natural Cause Accident 1=1Homicide Suicide g W Circumstances Investigation Medical Certifier Name Title 0 Noelle Stevens MD Address 1247 Dix Avenue, Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 83 Burial Date Cemetery,Crematory or Facility Name 09/28/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation opRemoval Date Place Removed and/or and/or Held - Hold Address 0 a Date Point of t/)❑Transportation p by Common Shipment Carrier Destination O Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 5 Address cc W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/27/2023 Registrar of Vital Statistics Aimee L Mahoney(ECectronicalty Signed) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Ih— Z Date of Disposition 9IZQ+ Place of Disposition i.i " Y CP.44114 Trf.t.t))) ILJ (address) W U) O (section) J�r � f (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premise I. e L Z 1 (please print)p W Signature Title ! it` DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on byrial,pgmit Official Funeral Directors Reg.or License# 4