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Osborn, Marilyn NEW YORK STATE DEPARTMENT OF HEALTH* - I Vital Records Section Burial - Transit Permit Name First Middle Last Sex Marilyn J Osbom Female Date of Death Age If Veteran of U.S.Armed Forces, 01/11/2018 85 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident E Homicide 0 Suicide El Undetermined ri Pending Circumstances Investigation • _° Medipal Certifier Name Title c Noelle Stevens MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 24 I Burial Date Cemetery or Crematory 01/16/2018 Pine View Crematory ■Entombment Address Cremation Queensbury, New York Date Place Removed im Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment by Common Destination Carrier • Disinterment Date Cemetery Address Q 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 Permission is hereby granted to dispose of the human remains described above as indicated. .,i. Date Issued 01/16/2018 Registrar of Vital Statistics gip6ertA Curtis(�ECectronicaICySigned) (signature) District Number 5601 Place Glens Falls, New York 2, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition//9-/4 Place of Disposition ) /lit1- v, CtA) G`,y✓t�. e,'y (address) (section) 1 (lot number) (grave number) Name of Sexton o P rs in Charge of Premises J t /iG-�1 t 4:N��if.-�' �1, �4r (please print) Signature Title e !Z' ✓ki 4._ (over) DOH-1555(02/2004)