Demarinis, Margaret 47T
NEW YORK STATE DEPARTMENT OF HEALTH r
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Margaret S Demarinis Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/25/2013 88 years War or Dates
Place of Death Hospital, Institution or
City, Tow /i XX Glens Falls Street Address Glens Falls Hospital
Manner of Death' latural Cause Accident El Homicide Suicide El Undetermined ri Pending
Circumstances Investigation
tu Medical Certifier Name Title
Sue A. Badera NP
Address
3 Irongate Plaza Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Tow)p)00ViGXX Glens Falls 5601 322
❑Burial Date Cemetery or Crematory
❑Entombment 07/26/2013 Pine View Crematorium
Address
•pgremation •Queensbury, NY 12804
Date Place Removed
Z❑and/or Removal and/or Held
F; Address
Hold
O - Date Point of
0 Li Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home 01130
Address
11 Lafayette Street Queensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
14, Remains are Shipped, If Other than Above
Address
t:
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/26/2013 Registrar of Vital Statistics Liu
(signature)
)
District Number 5601 Place Glens Falls I r�
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 7-- 113 Place of Disposition ,, pi,,,/ for,
(address)
1t1
Cl,
(section) d(lot
number) (' (grave number)
CI Name of Sexton or Perso in Charge of Premises �1 e*dt
(pie se print)
lijE Signature ".. Title Catoutk it2
V
(over)
DOH-1555 (02/2004)