Rosenblum, Marsha i' % n 75'i
NEW YORK STATE DEPARTMENT OF HE.)!A,I,.TH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marsha Rosenblum Female
Date of Death Age ( If Veteran of U.S. Armed Forces,
10 / 09 / 2017 67 War or Dates
Place of Death Hospital, Institution or
ZCity, Town or Village Wilton Street Address Interstate 87 North Town of Will
O Manner of Death❑Natural Cause �Accident Homicide E Suicide 0 Undetermined Pending
Circumstances Investigation
ig Medical Certifier Name Title
iQ Daniel J. Kuhn Coroner
Address
40 McMaster St., Ballston Spa., NY 12020
Death Certificate Filed District Number Regj ter Number
f
City, Town or Village Wilton q / &,
iiiamBurial Date Cemetery or Crematory 7
10 / 10 / 2017 Pine View Crematory
<'�8 Entombment Address
Wiiii! ECremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
O Date Point of
i 0 Transportation Shipment
by Common Destination
Carrier
ni
ii0Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
`i: Permit Issued to Registration Number
M:E Name of Funeral Home Compassionate Funeral Care 00364
Address
``< 402 Maple Ave. , Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
CC
ILI
Permission is hereby granted to dispose of the human remains described above as indicated.
iiiig Date Issued Op/- Registrar of Vital Statistics ��U 7/ J (sign re)
gi
District Number • Place Wilton , New York
' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
III Date of Disposition /a J 111 i1 Place of Disposition •Fn1il athltdrk,..
(address)
ill
CC (section) /// 11ot number) (grave number)
O Name of Sexton or Person in Charge of P emises 6 4:4 s
c-,A4 f
( ease print) -
1 Signature �i Title (tlj'i►1TV -
9 �-
(over)
DOH-1555 (02/2004)