Townsend, Marion NEW YORK STATE DEPARTMENT OF HEALTH 4 7.142'
Vital Records Section f Burial - Transit ermit
Name First Middle Last Sex
Marion E. Townsend Female
Date of Death Age If Veteran of U.S.Armed Forces,I. April 29, 2013 GO War or Dates NO
Z Place of Death Hospital, Institution or
W City,Town, or Village Whitehall Street Address Home
G Manner of Death ❑X Natural Cause ❑ Accident Ej Homicide 0Suicide ❑Undetermined ❑ Pending
W Circumstances Investigation
U Medical Certifier Name Title
W Bradley Berryhill MD
0 Address
Route 30N Castleton Family Health Center Bomoseen, Vermont 05732
Death Certificate Filed District Number r o Register Number 1
City,Town or Village Whitehall .5 a p c�.-
❑Burial Date Cemetery or Crematory
May 1, 2013 Pine View Crematorium
❑Entombment Address
❑X Cremation Town of Queensbury
Date Place Removed
0 Removal and/or Held
- and/or Address
I' Hold
Date Point of
0 ❑Transportation Shipment
a by Common Destination
Carrier
- Date Cemetery Address
ow0 Disinterment
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
2 Remains are Shipped, If Other than Above
IX
W Address
0.
Permission is hereby granted to dispose of the human remains described above as iqn f ated.
Date Issued `1) 3o) 1 3 Registrar of Vital Statistics a_ ( �v�1
(signature)
District Number 51 a-b Place Whitehall,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-
Z
W Date of Disposition S'1-13 Place of Disposition ZOu►.1 CanoctOu*-
2 (address)
W
N
0 (section) Xnumber) grave number)
0 <
O Name of Sexton or Person in Charge f Premises r,) cot-Vti
w (please rint)).��
Signaturedft Title4tllyt�ll
(over)
DOH-1555 (02/2004)