Marshall, Cindi NEW YORK STATE DEPARTMENT OF HEALTF y Burial - Tra sit Permit
Vital Records Section
Name First Middle Last Sex
Cindi L. Marshall Female
Date of Death Age If Veteran of U.S.Armed Forces,
August 2, 2013 55 War or Dates No
ZPlace of Death Hospital, Institution
LJ.1' City,Town or Village City of Albany or Street Address Albany Medical Center
0 Manner of Death ® Natural ❑ Accident ❑ Homicide ElSuicide ❑ Undetermined ❑ Pending
W, Cause Circumstances Investigation
W Medical Certifier Name Title
0 Jazelle Mealing MD
Address
43 New Scotland Ave., Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1471
Date Cemetery or Crematory
E Burial August 5, 2013 Pine View Crematory
❑ Entombment Address
® Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
O' ❑ and/or Address
_ Hold
U)
O Date Point of
Transportation Shipment
Cl) ❑ By Common p Carrier Destination
'
El Disinterment
Cemetery Address
Disinterment
Date Cemetery Address
El Reinterment
Permit Issued To Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Ce
W'
a.' Permission is hereby granted to dispose of the human remains described abov as ipdicate .
Date August 5, 2013 Registrar of Vital Statistics
Issued (signat e) /7 .e 1 f
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
~` Date of Disposition I I/I13 Place of Disposition 'Cw�/ + Le'►*StQt"r4`%,
W (address)
w
co
Q (section) (lot number) (grave number)
0I Aiifyier-WName of Sexton or Person in Charge of Premises P''•-L,
Signature G
(please print)
Si ✓�I`� Title CaeV�tz L
9
(over)
DOH-1555 (02/2004)