MacEwan, Marion NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit
Vital Records Section
Name First Middle Last Sex
Marion Elsie MacEwan Female
= Date of Death Age If Veteran of U.S.Armed Forces,
10/26/2016 92 War or Dates No
1--° Place of Death Hospital, Institution
Z City ,Town or Village City of Albany or Street Address Albany Medical Center
14 W: Manner of Death Natural Accident Undetermined Pending
® Cause ❑ ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
tof Medical Certifier Name Title
a Augustine Delago MD
Address
43 New Scotland Ave. Albany, NY 12208
Death Certificate Filed District Number Register Number
:' City,Town or Village City of Albany 101 2242
Date Cemetery or Crematory
❑ Burial 10/31/2106 Pine View Crematorium
❑ Entombment Address
®Cremation
Queensbury, NY
Date Place Removed
Z Removal and/or Held
0 0 and/or Address
Hold
U)
Date Point of
0.', Transportation Shipment
U.)' ❑ By Common Destination
O Carrier
❑ Date Cemetery Address
Disinterment
❑ Date Cemetery Address
Reinterment
Permit Issued To Registration Number
a Name of Funeral Home Regan & Denny Funeral Home 01444
-2, Address
94 Saratoga Ave. South Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
=, Remains are Shipped, If Other than Above
Address
D. Permission is hereby granted to dispose of the human remains decr' ve as indicated.
Date 10/28/2016 Registrar of Vital Statistics ��`"`
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accodance with this permit on:
z Date of Disposition II it 1 IL Place of Disposition ent9144 Cr411,ct'fN0—
� (address)
ui
tI)
tY (section) (lot number) (grave number)
0
Ci
WName of Sexton or Person in Charge of Premises �^r:s'A r J t'+t�11 ir-
(please print)
Signature a .v7 Title l'Z*61li
(over)
DOH-1555 (02/2004)