Scrafford, Marion NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
..;r.. Name First Middle Last Sex
Marion E. Strafford Female
:•r Date of Death Age If Veteran of U.S. Armed Forces,
rr May 4, 2014 91 War or Dates
iPl.:
ace of Death Hospital, Institution or
+ City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
gi Roslyn Socolof,MD
Address
?fir: Queensbury,NY
0:• Death Certificate Filed District Number Register Number
555
▪ City, Town or Village Glens Falls,NY 5601 G2o2,/
❑Burial Date Cemetery or Crematory
May 6, 2014 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO Removal and/or Held
and/or Address
P. Hold
N
O Date Point of
1 'Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
rr? Permit Issued to Registration Number
.:: Name of Funeral Home Regan Denny Stafford Funeral Home 01443
,r:;r Address
:.: 53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
i
▪ r
Permission is her y ranted to dispose of the huma remains described a€ove as in%icate•.
Date Issued >�6 Ob / Registrar of Vital Statistics d/,_,,,_, ,., of
(signature)
District Number 5601 Place Glens Falls,NY
}Y.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z ;� ( j
W Date of Disposition c 3--iii Place of Disposition �in/(104 C^..eltr,.._.
W (address)
Cl)
O (section) Alike
(lot number) (grave number)
p Name of Sexton or Person i Charge of Premises siw t
Z please pri
W Signature (t ...4.-0 Title C
1
(over)
DOH-1555(02/2004)