Cridge, Marion 1.4
NEW YORK STATE DEPARTMENT OF HEALTH r `` 7`
Vital Records Section Burial - Transit Permit
Name First - Middle Last Sex
Marion Elizabeth Cridge Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 9, 2014 78 War or Dates
Place of Death Hospital, Institution or
f` City, Town or Village Street Address 15 Snowberry Lane
Manner of Death 17r1.i Natural Cause ❑ Accident ❑ Homicide ❑ Suicide 0 Undetermined ri❑ Pending
Circumstances Investigation
y Medical Certifier Name Title
sa
Eric Pillemer, M.D
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District 1157,0
rnber Registember
City, Town or Village
❑Burial Date Cemetery or Crematory
December 12, 2014 Pine View Crematory
v❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
41,
❑Transportation Shipment
by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
` Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains describe a ye as indicated.
a; Date Issued / /i%i./Li Registrar of Vital Statistics -�^�C l
r signature)
District Number /S74',R Place , S7 , 11 /ds Ax, (f�.QQ , //(7 /)Fes?
17, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 12/12/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
Name of Sexton o er i Charge of Premises
se(plea print)
ClifriseSignature Title
(over)
DOH-1555 (02/2004)