Lyons, Marianne •
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
vi Name First Middle Last Sex
Marianne Lyons Female
Date of Death Age f Veteran of U.S. Armed Forces,
'Te#` 12/07/2017 79 Years War or Dates
'; Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death FA Natural Cause El Accident ❑Homicide El Suicide ❑Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 633
El Burial Date Cemetery or Crematory
12/12/2017 Pine View Crematory
El Entombment Address
fs ®Cremation Queensbury Town, New York
Date Place Removed
:4❑ and/or nd/or Held
and/or Address
VC Hold
Date -Point of
g.- }Q Transportation Shipment _
by Common Destination
Carrier
I,Q Disinterment
Date Cemetery Address
. Date Cemetery Address
Q Reinterment
Permit Issued to Registration Number
lit Name of Funeral Home Maynard D Baker Funeral Home 01130
r
'' Address
gin, 11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
1 Permission is hereby granted to dispose of the human remains described above as indicated.
7 4 9�Date Issued 12/11/2017 Registrar of Vital Stat stics gobertAcurtis �ECectronicaa Signed
ti-� y
(signature)
,, District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition /Ll( () Place of Disposition f?i0.,,,,i (, }p,..,
(address)
(section) 4 (lot number) (grave number)
Name of Sexton or Person in Charge of Premises at, gt; 40
(pe pent)
Signature 4 I-4147 Title it?-I t
(over)
DOH-1555 (02/2004)