Towers, Marion s `3 11 -1z6"-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marion J Towers Female
Date of Death Age If Veteran of U.S. Armed Forces,
tfe 09/24/2017 76 Years War or Dates
40
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death M Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
s Heather Madigan DO
44 Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 469
❑Burial Date Cemetery or Crematory
09/28/2017 Pineview Crematory
<4 Entombment Address
Oa®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
s Date Point of
❑Transportation Shipment
by Common Destination
91 Carrier
❑Disinterment Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
4.
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 09/26/2017 Registrar of Vital Statistics John TFram Ekctronicalb,Signed
(signature)
Vg
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
P q �7 Dispositioneft C• eA-0
s Date of DispositionZ$ Place of ✓
(address)
(section) it (lot number) r, (grave number)
T Name of Sexton or Person in Charge o Premises .Lrv . J 1Nti
itr
,;- ( ease print)
Signature /Il Title `1Z0/}P'-
(over)
DOH-1555(02/2004)