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Morse, Marian NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Trans it Permit - Name First Middle Last Sex ! Marian Louise Morse Female f Date of Death Age If Veteran of U.S. Armed Forces, 74 03/09/2018 93 Years Vl r or Dates Place of Death ' Hospital, Institution or _° City, Town or Village Cohoes Street Address Eddy Village Green Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ri❑Pending Circumstances Investigation r Medical Certifier Name Title ` Donald Jue MD Address .41 421 W Columbia St,Cohoes,New York 12047 Iv Death Certificate Filed District Number Register Number City, Town or Villa•e Cohoes 0102 30 ❑Burial Date Cemetery or Crematory 03/12/2018 Pine View • ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed " r—i❑Removal and/or Held P.-- and/or Address Hold Date Point of • ❑Transportation Shipment 1,°= by Common Destination Carrier f ElDisinterment Date Cemetery Address Pik J Reinterment Date Cemetery Address • ' Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address • 11 Lafayette St,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. • Date Issued 03/12/2018 Registrar of Vital Statistics LoriAnn'Yando(E(ectronica((ySigned) (signature) , EA District Number 0102 Place Cohoes, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: : Date of Disposition 3 0—it Place of Disposition ii;fvt. v;c r�('p,�1y4ry' (address) 'I (section) (lot number) (grave number) l'A Te,f rv�t. S T.t S Name of Sexton or Person in Charge of Premises Y 2S (please print) Signature Title c.R,Mgko r (over) DOH-1555 (02/2004)