Murrane, Martha Evelyn NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Martha Evelyn Murrane Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/05/2023 87 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
LU
p Manner of Death ❑^ Natural Cause []Accident ri Homicide DSuicide nUndetermined []Pending
W
C.) Circumstances I 'Investigation
W Medical Certifier Name Title
Philip Gara MD
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 102
Burial Date Cemetery,Crematory or Facility Name
12/05/2023 Pine View Crematory
IllEntombment Address
Cremation Queensbury Town,New York
Donation
O111Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
U)❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
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
Remains are Shipped,If Other than Above
5 Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/05/2023 Registrar of Vital Statistics Aimee L Mahoney(Electronically 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:
I-
Z Date of Disposition 1241, 173 Place of Disposition f jr�Et/,L"Frl/ Ge+E
W (address)
W
N (section) A (tot number) (grave number)
aName of Sexton or Person in Charge of Preees
t 1I�
/ (pl ase print)
W Signature Title 6M'`11
DOH-1555(07/18)p i of 2
1 ^ 7 3 0
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#