Bryant, Marian i' . Ili ( r7'
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marian Elizabeth Bryant Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/17/2017 84 Years War or Dates
-, Place of Death Hospital, Institution or
"' City, Town or Village Glens Falls Street Address Glens Falls Hospital
Ci Manner of Death X❑Natural Cause ❑Accident ❑Homicide ID Suicide 0 Undetermined El❑Pending
t Circumstances Investigation
la Medical Certifier Name Title
W. John Quaresima MD
At Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 538
❑Burial Date Cemetery or Crematory
10/18/2017 Pine View Crematory
;_2 II Entombment Address
gii
n ®Cremation Queensbury, New York
Date Place Removed
A..El❑Removal and/or Held
and/or Address
NHold
0 Date Point of
Q Transportation Shipment
by Common Destination
= Carrier
Disinterment
Date Cemetery Address
P
Li❑Reinterment
Date Cemetery Address
A
Permit Issued to Registration Number
T 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
Remains are Shipped, If Other than Above
{
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
44 Date Issued 10/18/2017 Registrar of Vital Statistics W96ert A Curtis EkctronicalTy Sig nee
(signature)
District Number Place
5601 Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
lDate of Disposition/D.-J 9_17 Place of Disposition pi), QI.,t C,re,y i-
(address)
J
tiv
al (section) (lot number) (grave number)
'� Name of Sexton o e n arge of Premises ii l-t/ C+. 644,41_4,,4..e.,
(please print)
Signature Title C /Grn.4.-le/
(over)
DOH-1555(02/2004)