Griffen, Marilyn NEW YORK STATE DEPARTMENT OF HEALTH ° �"' qb
Vital Records Section Burial - Transit Permit
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Name First Middle Last Sex
Marilyn A. Griffen Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 22,2018 78 War or Dates
4., Place of Death Hospital, Institution or
City, Town or Village Warrensburg Street Address 21 Elm Street
:p Manner of Death X Natural Cause Accident I Homicide Suicide Undetermined Pending
ILL Circumstances Investigation
4a Medical Certifier Name Title
a- Suzanne Bergin
Address
3767 Main Street,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660 21/-
0 Burial Date Cemetery or Crematory
October 25,2018 Pine View Crematory
❑Entombment Address
El Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
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I I Removal and/or Held
2 and/or Address
▪ Hold
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O Date r Point of
NTransportation Shipment
Q by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
;� Address
-- 3809 Main Street,Warrensburg,NY 12885
'' Name of Funeral Firm Making Disposition or to Whom
_1- Remains are Shipped, If Other than Above
Address
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a:
Permission is hereby granted to dispose of the huma remains escribed above a indicated.
Date Issued 1LU�as Iabl3 Registrar of Vital Statistics fh• 6 ��j� �j p
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%+" District Number 5660 Place Warrensburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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mi Date of Disposition it (It. II Place of Disposition e��,,r ?,
2 (address)
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pCL (section) (lot nuI er) (grave number)
Name of Sexton or Person in Charge of Premises Cots , s P,Ai1l
(please print)
W 1 Z Signature Title (2 MA i4/2
(over)
DOH-1555 (02/2004)