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Phelan, Marion NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Marion F. Phelan Female Date of Death Age If Veteran of U.S. Armed Forces, g July 29, 2017 104 War or Dates NA r>' Place of Death Hospital, Institution or City, Town or Village Town of Queensbury Street Address 28 Queens Lane Queensbury,NY 3. Manner of Death X Natural Cause [ I Accident I I Homicide n Suicide n Undetermined I ]Pending I Circumstances Investigation 1 , Medical Certifier Name Title Joseph C.Mihindu MD Address <. _i 20 Murray St. Glens Falls,NY 12801 Dea cate Filed District t Number inter Number X> Queensbury,City Town or,,Village Town ofNY i '—' ❑Burial Date Cemetery or Crematory August 1, 2017 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed ZZ n Removal and/or Held and/or Address H Hold N 0 Date Point of WI I Transportation Shipment p by Common Destination Carrier E. Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address iliii: 53 Quaker Road, Queensbury,NY 12804 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 e ains describe -above as indicated. if0 >> Date Issued ' I 1c)13) "-) Registrar of Vital Statistics --� l fl.-1.r--- ;:; _ ___, (signature) `''< District Numberc(Q c-) Place ( C-) —j-, d- 1 I certify that the remains of the decedent identified above were disposed of in a cordan a with this permit on: Z W — Date of Disposition ` Place of Disposition P," V'e , GG rrun '1' 2 (address) W co re (section) (lo number) (grave number) Q Name of Sexton or er n in Charge of Premises 3 t-v/[G.,t/. -#-i ecA.e Z (please print) W Signature Title 6.-/-2sn<„,1,,-- (over) DOH-1555(02/2004)