Pierce, Marjory f ,- , t 23U
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marjory E. Pierce Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/20/2017 72 years War or Dates
1.e Place of Death Hospital, Institution or
a City, ToXKXXVj(4INKX Saratoga Springs Street Address Saratoga Hospital
Manner of Death E,Natural Cause ❑Accident Homicide 0 Suicide riUndetermined El Pending
LCt Circumstances Investigation
ui Medical Certifier Name Title
Rodney Ying MD
Address
59 Myrtle Street Saratoga Springs, Ny
Death Certificate Filed District Number Register Number
City, ToliQXXXVAINKX Saratoga Springs 4501 140
«>❑Burial Date Cemetery or Crematory
❑Entombment 03/21/2017 Pineview Crematory
Address
Cremation Queensbury, N Y
Date Place Removed
Z Removal and/or Held
2 and/or Address
.= Hold
to
0 Date Point of
05 Q Transportation Shipment
Et' by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home 00448
Address
7 Sherman Ave, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
F,- Remains are Shipped, If Other than Above
Address
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Lf.` Permission is hereby granted to dispose of the human remains 'be aboveis in icated.
Date Issued 03/21/2017 Registrar of Vital Statistics "11•
(signature)
District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ill Date of Disposition.�/2 2//7 Place of Disposition Pdi e uj�� C.-/i✓hG
(address)/
Lu
to
cc (section) (lot tuber) (grave number)
0
G1 Name of Sexton or er n in Charge of Premises „S.,.-/1 a,/ es- 4-G4--e_
Z (please print)
Signature 1-- Title C 24-ri
(over)
DOH-1555 (02/2004)