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Lawrence, Maravene NEW YORK STATE DEPARTMENT OF HEALTI', 01 # 3l Vital Records Section Burial - Transit Permit Name First Middle Last Sex Maravene D. Lawrence Female Date of Death Age If Veteran of U.S. Armed Forces, June 10,2014 77 War or Dates . Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death [XI Natural Cause Accident I I Homicide Suicide Undetermined Pending Circumstances Investigation w Medical Certifier Name Title G Jennifer Donovan Address HHHN,North Creek,NY 12853 Death Certificate Filed District Number Register umber City, Town or Village Glens Falls 5601 g ❑Burial Date j Cemetery or Crematory El Entombment June 17,2014 j Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold U) O Date Point of coTransportation Shipment p by Common Destination Carrier Disinterment Date I Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 3809 Main Street, Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address LC' W Permission is hereby granted to dispose of the human r mains de ribed Bove assiindi 1ted. Date Issued Q(oI( ) Registrar of Vital Statistics �l� di( (signatt /ure) District Number 5601 Place Glens Falls '/ A? / I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w Date of Disposition b/1/1q Place of Disposition 'ttM�+t.J (n-•4i ... a (address) uJ Cl) a' (section) (7ot number)r (grave number) pName of Sexton or Person in Charge of Premises /1, -30*-r t$ w ( lease print) Signature (7��. / - Title CniElO(1 (over) DOH-1555 (02/2004)