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McCoy, Marion E.
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marion E.McCoy Female Date of Death Age If Veteran of U.S.Armed Forces, 02/02/2020 92 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address Haynes House of Hope p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined El Pending Circumstances Investigation C.) W Medical Certifier Name Title Ageel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 5 ©Burial Date Cemetery,Crematory or Facility Name 02/05/2020 Pine View Cemetery Entombment Address Cremation Queensbury,New York Donation Z Removal Date Place Removed O and/or and/or Held ~ Hold Address N O Nl Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address JE]Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom I- Remains are Shipped,If Other than Above Address Q W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/03/2020 Registrar of Vital Statistics ,7tnnyZ.r,d-Marte&(ElectronicallyS4owd)/ (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: E— W Date of Disposition 27 ��PlaceofDisposition 21 Ouarker Rd. Oueesnbury NY 12 4 (address) WSeneca 25A 1 N (section) (lot number) (grave number/ Name of Sext or�rson in Charge of mises Z (Please print) W Signature Thle e DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b' 010365 Receipt Human remains of 1 {( delivered on , 2a Fine View Cemeelw4 \ Representing the funeral home named on burial permit Official `` Funeral Directors Reg.or License�� .--