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Policastro, Marion Drault
�Sys NEW YORKSTATE DEPARTMENT OF HEALTH _y Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marion Draut Policastro Female Date of Death Age If Veteran of U.S.Armed Forces, 02/12/2020 89 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital 'p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending () Circumstances Investigation WQ Medical Certifier Name Title Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 76 Burial Date Cemetery,Crematory or Facility Name 02/13/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held d) Hold Address O IL Date Point of N ❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 W IL Permission Is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/13/2020 Registrar of Vital Statistics &6ert,4ndrew Curtis(ECectronicaCCy Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Z/ Tp Place of Disposition 17 i .j t l� 2 (address) W N (sedan) (lot number) (grave number) 8 Name of Sexton or Person in Charge of P 'ses AM _` l Z please print) W Signature ZTitle �t DOH-1555(07/M)p 1 of 2 Public Health Law Sec. 4145(2b) 013340 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#