Fleming, Marion NEW YORK STATE DEPARTMENT OF HEALT ‘ #Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marion L. Fleming Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 24, 2013 57 War or Dates
Place of Death Hospital, Institution or
Z' City, Town or Village Queensbury Street Address 23 Woodland Path
at
rt Manner of Death Natural Cause ❑Accident ❑Homicide n Suicide n Undetermined Pending
J. Circumstances Investigation
tu Medical Certifier Name Title
Mark Hoffman,MD
Address
Glens Falls,NY fa P
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury,NY 5657 ( 4
❑Burial Date Cemetery or Crematory
October 28, 2013 Pine View Crematory
III Entombment Address
0 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
CO
p Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
11,,, Permission is hereby granted to dispose of the human remains described above as indicated.
' Date Issued 1 ( laC) I" . Registrar of Vital Statistics c at "CJ ( natuY�r j
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordanceL.,/with this permit on:
w Date of Disposition If)/t11 3 Place of Disposition elk.) _49t0,6—
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re (section) d,(lo numberr (grave number)
Op Name of Sexton or Person in arge of Premises t%
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uJ Signature Title era l'n°Ii4�
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DOH-1555(02/2004)