Granger, Marianne z ' # tilt
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
Name First Middle Last Sex
Marianne E. Granger Female
Date of Death Age If Veteran of.U.S. Armed Forces,
i:,• June 4, 2016 91 War or Dates Place of Death
Hospital, Institutiorindiian River Rehab & Health Care
City, Town or Village Granville Street Address Center.Inc.
p Manner of Death I XI Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Na le�
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:{' Address
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Death Certificate Filed District Number Register Number
City, Town or Village Village Of Granville 5725 07/
❑Burial Date Cemetery or Crematory
El Entombment June 6, 2016 Pine View Crematorium
Address
❑x Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
i= . Hold
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0 Date Point of
n Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
•j1 Permit Issued to Registration Number
rr, Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is here anted to dispose of the human rem.'ns desc - abo s indicated.
:•••' /
r�' Date Issued � (l���d Registrar of Vital Statistics ��
'•:}: (signature)
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;;ti, District Number 5725 Place Village Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition Co i 9 ilk Place of Disposition 7 rivt ;_j
W (address)
CO
CL (section) da
(lot number), (grave number)
p Name of Sexton or Person in Charge of Premises ;I L ,S
Z (plese print)
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Signature L Title 17e_
(over)
DOH-1555(02/2004)