Garrand, Marie NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marie E. Garrand Female
RH Date of Death Age If Veteran of U.S. Armed Forces,
01/27/201 92 years War or Dates
P• lace of Death Hospital, Institution or
Z City, To VV -•- Street Address
11� �/ X � ♦ Glens Falls Glens Falls Hospital
W Manner o eat ,�'�Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
tit Medical Certifier Name Title
Joseph Mihindu M D
Address
20 Murray St, Glens Falls
ig Death Certificate Filed District Number Register Number
R. C• ity, Tow irxV X Glens Falls 56n1 40
❑Burial Date Cemetery or Crematory
`i ❑Entombment 011_2R/2013 Pine View Cemetery
Address
`�C9remation Oiieenshury, NY 12804
Date. Place Removed
Z Removal and/or Held
i 1-1
and/or Address
F- Hold
CO
Q Date Point of
s p Transportation Shipment
0 by Common Destination
iiim Carrier
El Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L. Kelly Funeral Home 00519
Mii Address
Schrnon I ake, N Y 12870
iiiiiq Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
CC
tili
P• ermission is hereby granted to dispose of the human remains described above as in icated.
Date Issued 01/28/2013 Registrar of Vital Statistics AZGit 'L
(signature)
District Number Place
5601 Glens Falls
s I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI• Date of Disposition I. 1`1-13 Place of Disposition >estilt0 C-1-etot i_--
a (address)
Ili
CC (section) (lot number) (grave number)
0 /�
is Name of Sexton or Person in Charge of Premises 4(.71 6,--- 3inr�tt'
(,$lease print)
Signature Title Cter^Pric
(over)
DOH-1555 (02/2004)