Sexton, Marie NEW YORK STATE DEPARTMENT OF HEALTH • 8" It till
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
MARIE SEXTON FEMALE
Date of Death Age If Veteran of U.S. Armed Forces,
C -19-2013 92 War or Dates
. Place of Death Hospital, Institution or
City, I'P ff TROYtil Street Address Seton Health,- St. Mary's Hospital
0 Manner of Death �; Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined Pending
tl Circumstances Investigation
tu Medical Certifier Name Title
44 Alan L. Crue Ni)
Address
L300 Massachusets Ave. Troy, NY
Death Certificate Filed District Number �e/b e� Register Number
City, NX TROY ID
< '❑Burial Date Cemetery or Crematory
7-22-2013 Pine View Crematory
❑Entombment Address
laCremation i l j Quake'. Road, Q-ieensuury, New York 1?�OL
Date Place Removed •
❑Removal , and/or Held
and/or
�; Address
CA
0 Date Point of
ti El Transportation Shipment
Cs by Common Destination
Carrier
[�Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home CARLETOti Funeral Home INC. 00281
Address ( ��
68 'gain Street, PO Box 67 Hudson Fails, NY l
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
• Address
f. :i Permission is her y anted t ispose of the human rem s e rib above s incl. d.
Date Issued 7 20 / 3 Registrar of Vital Statistics tyJ
(signature)
it District Number (,( /O?. Place T, rt jky. /-1 (v
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i''';'
tilDate of Disposition `1-L3-L3 Place of Disposition �Vk) Cecf fr1.
a (address)
w
to
CC (section) , lot ium er) �^^ (grave number)
Name of Sexton or Perso in Charge of Prises E/)( it ki" Jt }}
i (p/easprint)
iiiSignature w^ Title C1 m�4'Ctl9
(over)
DOH-1555 (02/2004)