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Martell, Laureen NEW YORK STATE DEPARTMENT OF HEALTH # '74 Vital Records Section 3 ,� Burial - Transit Permit :- Name First Middle Last Sex Laureen Martell , Female ' Date of Death Age If Veteran of U.S. Armed Forces, May 19, 2012 65 War or Dates Zx Place of Death Hospital, Institution or , City, Town or Village Glens Falls Street Address Glens Falls Hospital 1 , Manner of Death - Natural Cause —Accident I I Homicide Suicide Undetermined —Pending abi#' Circumstances Investigation Medical Certifier Name Title lam' Address Death Certificate Filed District Number Regi ter umber City, Town or Village Glens Falls 5601 ❑Burial Date Cemetery or Crematory El Entombment May 23,2012 Pine View Crematory Address ©Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed Z Removal and/or Held 9 and/or Address 1:: Hold to O Date Point of ej I j Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address H Renterment Date Cemetery Address .:., Permit Issued to Registration Number Name of Funeral Home Regan.& Denny Funeral Home 1 01444 Address 94 Saratoga Avenue, South Glens Falls,NY 12803 °r= Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Zr, Address I ' Ili := Permission is hereby granted to dispose of the human remains described a-bb ve, i ed. Date Issued t 12`Registrar of Vital Statistics � ✓ L (signature) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 5/Z3)lZ Place of Disposition c;,..4 fjtti.,1 6iclLLzrl0+.L 2 (address) W W (section) Jy t (lot numbed(' (grave number) pName of Sexton or Person in Charge of Premises l h ids{ li ' J(404 Z P (please print) W Signature /A(6pk Al__- Title Cr1.=M)f tO.- (over) DOH-1555(02/2004)