Granger, Marion NEW YORK STATE DEPARTMENT OF HEALTH 35 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marion Granger Female
Date of Death Age If Veteran of U.S.Armed Forces,
1., May 6, 2016 87 War or Dates
Z Place of Death Hospital, Institution or
W City,Town,or Village Granville Street Address Indian River Rehabilitation and
G Manner of Death n Natural Cause ri Accident Ili Homicide El Suicide 0 Undetermined 0 Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W Dr. Sean Bain Dr.
0 Address
100 Park Street, Glens Falls, NY 12801
Death Certificate Filed District Numbe Register Number
City,Town or Village Granville 57A I 5
❑Burial Date Cemetery or Crematory
May 11, 2016 Pineview Crematorium
❑Entombment Address
0 Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
0 El Removal and/or Held
and/or Address
I' Hold
0 Date Point of
0 El Transportation Shipment
d by Common Destination
iCarrier
Date Cemetery Address
a ❑ Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
x• Remains are Shipped, If Other than Above
W Address
a
Permission is hereby ranted to dispose of the human remains des indicated.
Date Issued 5 fI i(p Registrar of Vital Statistics
signature
District Number 57)5 Place Granville,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
w Date of Disposition 05/11/2016 Place of Disposition Pineview Crematorium
2 (address)
W
ft
0 (section) jot number) (grave number)
O Name of Sexton or Person in Charge of Prem4ises (,Lnq L S
W 1 (please print)
Signature G( Title a0
(over)
DOH-1555 (02/2004)