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Russell, Marcus NEW YORK STATE DEPARTMENT OF HEALTH* i t Z37 Vital Records Section Burial - Transit Permit ° Name First Middle Last Sex Marcus W. Russell Male Date of Death Age If Veteran of U.S. Armed Forces, May 3,2011 63 War or Dates Vietnam Place of Death #� Hospital, Institution or City, Town or Village Warrensburg Street Address 85 Library Ave., A3 ci Manner of Death X Natural Cause Accident [ I Homicide ( !Suicide !Undetermined Pending Wi t.I' Circumstances Investigation j Medical Certifier Name Title Q Joseph C.Mihindu Address ' 20 Murray Street,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number�/ I City, Town or Village Warrensburg 5660 / ❑Burial Date Cemetery or Crematory [Entombment May 4,2011 Pine View Crematory Address ©Cremation Quaker Rd.,Queensbury,NY 12804 Date Place Removed Z Removal and/or Held O and/or Address H Hold rn O Date Point of N 1 1 Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address ( I Reinterment Date Cemetery Address 1, Permit Issued to Registration Number , Name of Funeral Home Alexander-Baker Funeral Home 00035 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above a Address W. fit.; Permission is hereby granted to dispose of the human re ai descr' ed above as ' dicated. Date Issued .i f/ Registrar of Vital Statistics �J/ (sigr�ture t ' District Number 5660 Place Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Lu Date of Disposition -VI,( Place of Disposition Pouqtru Crifwct•r1v..- W (address) OC (section) i (I umber) (grave number) Op Name of Sexton or Pe son in Charg of Premises P•i4 yet.- • .w.,&}' Z a t (please print) W 1 L Signature Title CQtrorr0$ (over) DOH-1555 (02/2004)