Loading...
Harriman, Marjorie IF 041S NEW YORK STATE DEPARTMENT OF HEAL T.N Vital Records Section Burial - Transit Permit Name First Middle Last Sex Marjorie Mae Harriman Female Date of Death Age If Veteran of U.S. Armed Forces, May 6, 2012 95 War or Dates Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address The Pines W Manner of Death J Natural Cause Accident Homicide Suicide LiUndetermined El Pending Circumstances Investigation ©` Medical Certifier Name Title Roslyn Socolof_MD, Address 100 Broad St Plaza Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village 5601 ."") 1 ) ❑Burial Date Cemetery or Crematory May 11, 2012 Pine View Crematorium ❑Entombment Address OCremation Quaker Road Queensbury,NY 12804 Date Place Removed z El Removal and/or Held and/or Address } Hold Date Point of 0, ❑Transportation Shipment N by Common Destination `1 Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom t Remains are Shipped, If Other than Above 2 Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 5/9/(2 Registrar of Vital Statistics ' V (signature) District Number 5601 Place (rQ,,,.s Co. L\s ) y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ' Date of Disposition 1l W P S ��(!1 Place of Disposition ��vtc.mi �rnerkoriur. W (address) G? r (section) (lot number) (grave number) Name of Sexton or Perso in Charge of remises co.} Z' lease print) W- Signature Title GA3i#/1 Pt OA (over) DOH-1555 (02/2004)