Kercado, Marion 4 - N 4 (oi
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
;:? Name First Middle Last Sex
Marion Kercado Female
], Date of Death Age If Veteran of U.S. Armed Forces,
06 / 01 / 2017 78 War or Dates N/A
}- Place of Death Hospital, Institution or
3Z City, Town or Village Wilton Street Address 83 Edie Road
O Manner of Death®Natural Cause E Accident El Homicide E Suicide �Undetermined �Pending
it# Circumstances Investigation
0.
til Medical Certifier Name Title
Xiao Su MD
Address
6 Medical Park Drive Malta, NY 12020
! Death Certificate Filed District Number 4/t5(,9
Register Number
City,Town or Village Wilton
OM ElBurial Date /_ Cemetery or Crematory
W / 7/ 2ol/ Pine View Crematory
(Entombment Address
iiiig ECremation Queensbury, NY
Date Place Removed
44 IT❑Removal and/or Held
and/or Address
0
Hold
0 Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
iBii 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
Z Address
CC
lU
# ` Permission is hereby granted to dispose of the human remai s described above as indicated.
iin Date Issued Ce off-/J ri Registrar of Vital Statistics c j'3 Lk
(signature)
)
Wi
District Number 1.15-6,7 Place Wilton , New York
1 : I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
IU Date of Disposition Galin Place of Disposition ?i,6ie. rrr ori'✓
(address)
id
CO
fr (section) (lot number) (grave number)
IIName of Sexton or Person in Charge of Premises ��f� lh ��^�t
/' ' (p ase punt) -
Signature G� 47 Title ( - 'Mgt
(over)
•
DOH-1555 (02/2004)