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Searles, Marion NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit a, Name First Middle Last Sex t "'y Marion I. Searles Female Date of Death Age If Veteran of U.S. Armed Forces, June 6, 2012 61 War or Dates 44 Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital QManner of Death I�Natural Cause n Accident n Homicide Suicide n Undetermined Pending Circumstances Investigation S; Medical Certifier Name Title Frances Bollinger MD Address x 161 Carey Rd. Queensbury,NY 12801 L r° Death Certificate Filed District Number Register umber City, Town or Village Glens Falls 5601 off ©Burial Date Cemetery or Crematory ❑Entombment June 12,2012 Pine View Cemetery Address ❑Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed Z I I Removal and/or Held O and/or Address H Hold co O Date Point of y I I Transportation Shipment p by Common Destination Carrier !Disinterment Date Cemetery Address I (Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan & Denny Stafford Funeral Home 01443 Address 53 Quaker Road,Queensbury,NY 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 IJ)///2. Registrar of Vital Statistics C�/y,� -D (signature District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition6/1 2/1 2 Place of Disposition Pine View Cemetery la 2 (address) ✓ Free Ground 36 (section) (lot number) (grave number) Q Name of Sexton or Person ' Charge of Premises Michael Genier Z (please print) La Signature Title Superintendent (over) DOH-1555(02/2004)