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Brown, Marjorie -7g7 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Marjorie Mary Brown Female Date of Death Age If Veteran of U.S.Armed Forces, 10/20/2017 95 Years War or Dates Place of Death Hospital, Institution or City,Town or Village Queensbury Town Street Address Westmount Health Facility Manner of DeathUndetermined Pending ©Natural Cause ID Accident Homicide Suicide❑ ❑ ❑ Circumstances Investigation Medical Certifier Name Title Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town,New York 12804 may. - Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 134 ❑Burial Date Cemetery or Crematory 10/24/2017 Pine View Crematory El Entombment Address Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address k, Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/24/2017 Registrar of Vital Statistics caru&ne2fBar6er E(ictronicalTysigned" (signature) District Number Place 5657 Queensbury, New York I certify that the remains of the decedent idented above were disposed of in accordance with this permit on: Date of Disposition /a 125. Place of Disposition folt � one,✓ "I (address) (section) /t(lot number) f (grave number) t Name of Sexton or Person in Charge of Premises eii4t (please print) Signature G�� >� Title ai A— (over) DOH-1555(02/2004)