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Cook, Marion NEW YORK STATE DEPARTMENT OFZHEALTH `j S Vital Records Section Burial - Transit Permit Name First Middle Last Sex Marion Cook Female : Date of Death Age If Veteran of U.S. Armed Forces, December 24, 2016 88 War or Dates f, Place of Death Hospital, Institution or City, Town or Village Argyle Street Address Washington Center Manner of Death J Natural Cause ❑ Accident ❑ Homicide ❑ SuicideriUndetermined ri Pending Circumstances Investigation rt3 Medical Certifier Name Title Jennifer Hayes, Address 10421 State Route 40 Granville, NY 12832 Death Certificate Filed District Number - Register Number City, Town or Village Argyle 5756 5-3 3.❑Burial Date Cemetery or Crematory December 28, 2016 Pine View Crematory ❑Entombment Address • ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed n❑ Removal and/or Held _- and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier _ Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home-Argyle • 01077 Address 123 Main St., Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address -3 Permission is hereby granted to dispose of the human r ains described above as indicated. 4 Date Issued /a/ al/ /b Registrar of Vital Statistics � (� th ,4,,,,�,w J (signature) District Number 575 Place `,(Q. kil, ''• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 29 Date of Disposition 12/6/2016 Place of Disposition Quaker Road Queensbury,NY 12804 R)IgUreti) .i'Qw/,�.y (address) // (section) 1 (lotn mber) (grave number) Name of Sexton o e s in Charge of Premises - Lc.)I O-i �-J4�i 6-`e. (please print) • Signature ,$�� Title G rev4t4. d.� (over) DOH-1555 (02/2004)