Huntington, Marilynn NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
44 Marilynn Joyce Huntington Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 22, 2011 67 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Granville Street Address INDIAN RIVER REHAB & HLTH CARE
Manner of Death I I I I ❑ Undetermined ❑ Pending
X Natural Cause Accident Homicide Suicide g
Circumstances Investigation
u Medical Certifier Name Title
Max Crossman MD,
Address
North St. Granville, NY 12832
Death Certificate Filed District Number Registermber
City, Town or Village 5/075' /
'®Burial Date Cemetery or Crematory
July 26, 2011 Pine View Cemetery
❑Entombment Address
DCremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
Hol and/or Address
Pine View Cemetery
Date Point of
, ❑Transportation Shipment
by Common
Destination
Carrier
III Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
1k;
Permission is here y gran -•ted to dispose of the human remains esorib :bo as indicated.
Date Issued 7 a5 /� Registrar of Vital Statistics A a a.....,..____
(signature)
District Number 5725. Place 6fitnt'i'1`P. A/
„_ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
st ( Date of Disposition 7/26/11 Place of Disposition Pine View Cemetery
(address)
r
Ondawa 31 A 4 4
(section) (lot number) (grave number)
7 Name of Sexton or Person ' Charge of Premises Michael Genier
(please print)
Signature • ` ti"1'1", Title SupErintendcnt
(over)
DOH-1555 (02/2004)