Sheehan, Marlene 4 , lo'
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marlene 0 Sheehan Female
r:r Date of Death Age If Veteran of U.S. Armed Forces,
August 29, 2016 76 War or Dates
''.'r 1 Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 96 Farr Lane
Manner of Death g Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
.CI Robert Reeves Dr.
;tip Address
rj: 3 Irongate Center,Glens Falls,NY 12801
r:;r Death Certificate Filed District Number R gister Number
i c City, Town or Village Queensbury 5657 ��
❑Burial Date Cemetery or Crematory
August 31, 2016 Pine View Crematorium
❑Entombment Address
N Cremation 51 Quaker Road,Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
0 Date Point of
35 ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
rr Permit Issued to Registration Number
:1: Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Kii Address
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 remains described abov as indicated.
.jam!
Date Issued�'�(')l I Co Registrar of Vital Statistics -4 �� C r—
(signature)
District Number 5657 Place Queensbury
H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition I(( /IL Place of Disposition rntUcep L mcf c►r,N.
2 (address)
W
U)
0 (section) (lot number). (grave number)
pName of Sexton or Person in Charge of Premises Lt-o-, L " f
Z /� please print)
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Signature LI Title l n—
(over)
DOH-1555(02/2004)