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Marra, Christine . : $yob NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Christine E. Marra Female Date of Death Age If Veteran of U.S. Armed Forces, February 15, 2015 55 War or Dates Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death n Natural Cause n Accident ❑Homicide Suicide Undetermined Pending 141 Circumstances Investigation W Medical Certifier Name Title O John P. Stoutenburg Dr. Address Glens Falls Hosp,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number F/ City, Town or Village Glens Falls 5601 `f ❑Burial Date Cemetery or Crematory February 17, 2015 Pine View Crematorium ❑Entombment Address ©Cremation 21 Quaker Road,Queensbury, NY 12804 Date Place Removed ZO U Removal and/or Held and/or Address H Hold N O Date Point of Nn Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address Renterment Date Cemetery Address Permit Issued to Registration Number 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 a Address w n' Permission is hereb granted to dispose of the human remains described above as ind' ated Date Issued I Registrar of Vital Statistics O? ' ` (signature) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above wer disposed of in accordance with this permit on: Z W Date of Disposition Z/i cjic' Place of Disposition TA 4 ILI C c',..., 2 (address) W Cl) CC (section) 4(lot number) (grave number) QName of Sexton or Person in Charge of Premises rsrr 4ei Z (ple se print W Title Ca +fit, Signature d._ .,t.� (over) DOH-1555(02/2004)