Hall, Marvin NEW YORK STATE DEPARTMENT OF HEALTH , (i
Vital Records Section
B rial - Transit Permit
Name First Middle Last Sex
Marvin Clarence Hall Male
e Date of Death Age If Veteran of U.S. Armed Forces,
April 1, 2013 89 War or Dates World War II
Z Place of Death Hospital, Institution or
w City, Town or Village Queensbury Street Address The Stanton Nursing & Rehab. Center
in Manner of Deathini Natural Cause n Accident El Homicide Eil Suicide ElUndetermined � Pending
111
Circumstances Investigation
W Medical Certifier Name Title
C Suzanne Blood, M.D. Dr.
Address
14 Manor Drive Queensbury, NY 12804
Death Certificate Filed Dict Number R ;stir Number
City, Town or Village b
❑Burial Date Cemetery or Crematory
April 2, 2013 Pine View Crematorium
❑Entombment Address
1 II Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z El Removal , and/or Held
o and/or Address
}... Hold GERALD B.H. SOLOMON NAT.
0 Date Point of •
Transportation Shipment
J by Common Destination
CI' Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
p- Remains are Shipped, If Other than Above
2' Address
ft
LEJ
'" Permission is hereby granted to dispose of the human rerra' s described abbe as indicated.
l
Date Issuedt o�l �_
Registrar of Vital Statistics , q, ,)f�,`
,------, (signature)
District NumberS( S ' ) Place t cD L.�--r\ (DC l�L�...s2-_Q-, ,S
I certify that the remains of the decedent identified above were disposed of in a Gordan a with this permit on:
F-
WDate of Disposition 4-3-t3 Place of Disposition 4?.Vaw C., etaw.-
2 (address)
El]:
c (section) d (lot number)r (grave number)
Name of Sexton or Pers n in Charge of Premises ,si r YMr/tt
en ( lease print)
z
'W Signature Title ce tm t 0i
(over)
DOH-1555 (02/2004)