Booden, Marilyn NEW YORK STATE DEPARTMENT OF HEALTH tt
Vital Records Section c .. Burial - Transit Permit
Name First Middle Last Sex
Marilyn Kay Booden Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/11/2018 75 years War or Dates No
• Place of Death Hospital, Institution or
W 560aown or V v"XX Glenville Street Address 72 Fredericks Rd
i> Manner of Death❑�,iatural Cause ❑Accident ❑Homicide ❑Suicide r-i❑Undetermined El Pending
LU Circumstances Investigation
W Medical Certifier Name Title
ra Mina Sun M f)
Address
463 Saratoga Road, Glenville, N Y 12302
M. Death Certificate Filed District Number Register Number
O$cxxown or VjOjagxx Glenville 4651 9
i>❑Burial Date Cemetery or Crematory
❑Entombment 01/16/2018 Pineview Crematory
Address
❑+Cremation Queensburi, N Y _ __
Date Place Removed
Z Removal 1 and/or Held
2❑and/or Address�
Hold
O Date Point of
co❑Transportation Shipment
C1 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Baker Funeral Home 01130
Address
11 LaFayette St. Queensbury, N.Y. 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
„ Address
11
U
a" Permission is hereby granted to dispose of the human re ains descri• • above as indic ted. .�
Date Issued 01/16/2018 Registrar of Vital Statistics ai S ,a c
(sig ature)
District Number 4651 Place Glenville
II certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Litt Date of Disposition ///1[if Place of Disposition f.,a.. 49. ,...-
2 (address)
Ui
fil
C (section) of number) (grave number)
ci Name of Sexton or Person in Charge of Premises s 4449
Z (ple se print)
14.,Signature it Title feiVii Pin_
(over)
DOH-1555 (02/2004)