Loading...
Hyde, Margot . . . pl/ Z- 4 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margot Hyde Female Date of Death Age If Veteran of U.S.Armed Forces, 12/10/2023 91 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 9 Adams Road,Moreau Town,New York 12803 UJ apManner of Death IllNatural Cause Accident El Homicide Suicide Undetermined ElPending Circumstances II ''Investigation W Medical Certifier Name Title 0 Sean Campanie NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 71 Burial Date Cemetery,Crematory or Facility Name 12/12/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation O❑Removal Date Place Removed and/or and/or Held f- Hold Address N 0 d Date Point of M IIITransportation Shipment p by Common Carrier Destination ElDisinterment Date Cemetery Address 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 l• Remains are Shipped,If Other than Above i Address It W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/12/2023 Registrar of Vital Statistics Brenda Hutter(Electronically Signed) (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: I— : / Z Date of Disposition I"21Iy IT Place of Disposition F UJ (address)J � A�e'V� W N CC (section) (lot n berl /grave number) S Name of Sexton or Person in Charge of miser ^ '1 �� z (pleaseti prim! W Signature Title '" '"'� l" 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 burial permit Official Funeral Directors Reg.or License#