Durkin, Marion NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section > Burial - Transit Permit
Name First Middle Last Sex
Marion Rose Durkin Female
Date of Death Age If Veteran of U.S.Armed Forces,
F January 25, 2012 98 War or Dates NO
Z Place of Death Hospital, Institution or
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
a Manner of Death ®Natural Cause ❑ Accident ❑Homicide ❑Suicide ❑Undetermined ❑ Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W Dr. Cunningham MD
0 Address
3 Iron Gate Glens Falls New York 12801
Death Certificate Filed District Numberr4�(6 Register Number l
City,Town or Village Glens Falls
❑Burial Date Cemetery or Crematory
January 27, 2012 Pine View Crematorium
❑Entombment Address
®Cremation 21 Quaker Road Queensbury New York 12801
Date Place Removed
0 ❑Removal and/or Held
- and/or Address
1' Hold
0 Date Point of
0 ❑Transportation Shipment
d by Common Destination
Carrier
- Date Cemetery Address
0 ❑Disinterment
E Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
cece Remains are Shipped, If Other than Above
W Address
O.
Permission is hereby granted to dispose of the human remains de&cribed,above as indicated.
Date Issued i 1 .610 , a Registrar of Vital Statistics 1
y (signature)
District Number J 7a 0 Place Glens Falls,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F
Z
W Date of Disposition j/11 I r2 Place of Disposition Gerald B. H. Solomon Saratoga National Cemet
2 (address)
W
1.4
d (section) (ot number) (grave number)
D Name of Sexton or Person i Charge of Pre es A, 1� M
Z please print)
W Ilk , Title C Q E en 1\T&t Signature
(over)
DOH-1555 (02/2004)