Russell, Marion NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marion Cecil Russell Female
Date of Death Age If Veteran of U.S. Armed Forces,
04/15/2018 75 Years War or Dates
Place of Death Hospital, Institution or
k`! City, Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Roslyn Socoiof MD
Address
42 Gurney Ln,Queensbury Town,New York 12804
rig
Death Certificate Filed District Number Register Number
• City, Town or Village Queensbury 5657 53
❑Burial Date Cemetery or Crematory
04/23/2018 Pine View Crematory
❑Entombment
Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held _
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Li Disinterment Date Cemetery Address
• ❑Renterment 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
0.
Permission is hereby granted to dispose of the human remains described above as indicated.
44, Date Issued 04/17/2018 Registrar of Vital Statistics Caroline If Barber(ECectronicaffySigned)
(signature)
• District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 'I/n it Q Place of Disposition
(address)
4.4 (section) /J (lot number) (grave number)
Name of Sexton or Person in Charge of Premises `- M^
(p ase print)
yl Signature - Title 111 2
(over)
DOH-1555(02/2004)