Stoken, Marion ff3m
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Marion Stokem Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/13/2020 87 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Hartford Town Street Address 60 Skyview Meadows, Hartford Town, New York 12838
p Mannerof Death ®Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Thomas Coppens MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Hartford 5759
Burial Date Cemetery,Crematory or Facility Name
04/14/2020 PineView Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
Q Removal Date Place Removed
and/or and/or Held
E- Hotd Address
to
O
(- Point of
N Transportation Date
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01117
Address
18 George St Po Box 277,Fort Ann,New York 12827-0277
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/13/2020 Registrar of Vital Statistics Denise Petteys(Electronically Signed)
(signature/
District Number 5759 Place Hartford, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F—
W Date of Disposition /J—/9-Zp Zp Place of Disposition ]�� r`�
2 (address)
w
� (section) llat umber/ (grave number)
Name of Sexton or Perso C r p o remises 1' G'� G print)
Z (please p p
Lu Signature Title L/e
DOH-1555(07/18)p I of 2
1do
Public Health Law Sec. 4145(2b) Q 1,3 6
Receipt
Human remains of %i j delivered on , 20 '
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ';% `