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Magee, Martha s81 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit :i.-i Name First Middle Last Sex : : Martha M. Magee Female hs Date of Death Age If Veteran of U.S. Armed Forces, ''''i' September 19, 2014 80 War or Dates Vietnam Place of Death Hospital, Institutiorl>Qdian River Rehab & Health Care City, Town or Village Granville Street Address Center.Inc. Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title r Sean Bain Address ;rV.,, 100 Park St,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number ,r,5$ City, Town or Village Village of Granville 5725 7 ��se ❑Burial Date Cemetery or Crematory ❑Entombment September 22, 2014 Pine View Crematory Address ❑x Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold N 0 Date Point of Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 ':; Address 53 Quaker Road, Queensbury, NY 12804 r��▪:•: Name of Funeral Firm Making Disposition or to Whom t:+ Remains are Shipped, If Other than Above Address Permission is h/ ,S/Y'Registrar by nted to dispose of the human re s desc ibed :b as indicated. irl ,r Date Issued ©f of Vital Statistics 1 •/ `:X i,, (signature) •'.:. District Number 5725 Place Village of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z !� �p W Date of Disposition 91azkj Place of Disposition �C,,,,�ll'w (it-40f*✓ 2 (address) W CO 0 (section) (lot numb`)- (grave number) ZZ Name of Sexton or Person in Charge of Premises Ar,, 1.,•►� , ,JNn tk(please print) Signature A. Title CrK Allot, (over) DOH-1555(02/2004)