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O'Kane, Theresa Mary NEW YORK STATE DEPARTMENT OF H EALTH0Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Theresa Mary O'Kane Female Date of Death Age If Veteran of U.S.Armed Forces, 10/21/2023 93 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 198 Bluebird Road,Moreau Town,New York 11.1 `p Manner of Death Natural Cause Accident Homicide ESuicide Undetermined El Pending Circumstances Investigation aal Medical Certifier Name Title David Cunningham MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 60 Burial Date Cemetery,Crematory or Facility Name A 10/27/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held _ • Hold Address 0 O. Date Point of CO ElTransportation El. by Common Shipment Carrier Destination Disinterment Date Cemetery Address nReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 5 Address fY W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/24/2023 Registrar of Vital Statistics Brenda J(utter(E1 ctronical2ySigned) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition /O 29- 2073 Place of Disposition r';1je ✓ g ,� er ei. 4.40 f3 2 (address) W N Q /section) (lot number (grave number) Name of Sexton or Person in Charge o rem' es( VA, � t (please pant) W Signature l Title iJ yea. DOH-1555(07/18)p 1 of 2 L)—I ‘-‘ .2i. 1 I:" 1 4 Public Health Law Sec. 4145(2b) Receipt - , , r Human remains of delivered on .'• • , 20 ... .. -•••--,-, .,/, ;Il , ,•" I Pine'View Cemetery Representing the funeral home named,o1 buriabpAmit Official Funeral Directors Reg. or License#