Beaudet, Marielle ... . - k It 51-Q,
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
MarleneL. ' - Beaudet Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 11,2012 , 82 War or Dates
t- Place of Death Hospital, Institutiorirondack Tri-County Health Care
Z City, Town or Village Johnsburg Street Address Center
pManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
ul Circumstances Investigation
uj Medical Certifier Name Title
a Dr.John Sawyer,MD
Address
14 Manor Drive,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg 5655 3 5
❑Burial Date Cemetery or Crematory
Ill Entombment October 12,2012 Pine View Crematory
Address
LI Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F_- Hold
O Date Point of
Sj I I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date I Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Dumber
Name of Funeral Home Alexander-Baker Funeral Home oo613,3
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped, If Other than Above
2 Address
to
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Permission is hereby granted to dispose of the human rem ins described ove as indicated.
Date Issued join/ 9 of , Registrar of Vital Statistics �( �t J�C.c • 8
2-, (. (signature)
District Number 5655 Place Johnsburg
i-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tu Date of Disposition I0-0-i Z Place of Disposition 2crefti4of
v...2 (ass)
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Le
(section) (lot number) (grave number)
a Name of Sexton or Person in Charg of Premises //,
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Signature Title
(over)
DOH-1555 (02/2004)