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Dawes, Marjorie r /001 NEW YORK STATE DEPARTMENT OF HEALTH, 4 ,•,,,, Vital Records Section Burial - Transit Permit r Name First Middle Last Sex • Marjorie S.Dawes Female Date of Death Age If Veteran of U.S. Armed Forces, 12/18/2018 95 Years War or Dates • Place of Death Hospital, Institution or • City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc Manner of Death©Natural Cause Ei Accident 0 Homicide 0 Suicide ri Undetermined FlPending Circumstances Investigation Medical Certifier Name Title ( Eric Santell NP Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City, Town or Village Saratoga Springs 4501 666 ❑Burial Date Cemetery or Crematory 12/19/2018 Pine View Crematory `v(]Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ; ❑Removal and/or Held and/or Address Hold Date Point of Transportation Shipment r by Common Destination Carrier [�Disinterment Date Cemetery Address Q Renterment Date Cemetery Address zo 1,41 Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 5 ; 11 Lafayette St,Queensbury,New York 12804 -,' Name of Funeral Firm Making Disposition or to Whom 40 Remains are Shipped, If Other than Above Address rzr Permission is hereby granted to dispose of the human remains described above as indicated. w: Date Issued 12/19/2018 Registrar of Vital Statistics Sohn P cFranck(E(ectronically Signed) (signature) District NumberAt 4501 Place Saratoga Springs, New York 41 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i Date of Disposition I-Va41l Place of Disposition +.•& V. t w Crtr•`for= �r . (address) (section) /v) i (Iq number)' (grave number) Name of Sexton or Person in Charge of Premises / ': �e 1 r�►�c e .,. (please print) Signature Title Cter�21, (over) DOH-1555 (02/2004)