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Workman, Catherine Estelle
it Do NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Catherine Estelle Workman Female Date of Death Age If Veteran of U.S.Armed Forces, 02/03/2024 64 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Wilton Town Street Address 314 Louden Road Lot 44,Wilton Town, New York 12866 tL• Manner of Death Undetermined Pending Natural Cause Accident Homicide Suicide LU Circumstances Investigation C.) W Medical Certifier Name Title CI David DeCelle Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed Town Of Wilton District Number Register Number City,Town or Village 4569 9 Burial Date Cemetery,Crematory or Facility Name 02/06/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZZ❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 t1 Date Point of N Transportation p by Common Shipment Carrier Destination 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 Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/06/2024 Registrar of Vital Statistics Susan Baldwin(ECectronicaI( Signed) (signature) District Number 4569 Place Town Of Wilton I certify that the remains of the decedent identified above wer. ';exposed of in accordance with this permit on: • W Date of Disposition 211124 Place of Disposit '(� fuxLJ (elf rr►�1TD+�a� 2 (address) W CC N (section) (lot nu (grave number) O Name of Sexton or Person in Charge of Premises b' s �— /� !� (please print) Z W Signature Title 1 T a DOH-1555(07/18)p 1 of 2 a C 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#