Collier, Marsha Kay II? L
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Marsha Kay Collier Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/28/2020 78 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Kingsbury Town Street Address 1767 State Route 196, Kingsbury Town,New York 12828
11.1
`p Manner of Death Natural Cause ❑Accident 0 Homicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Jennifer Stratton MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Kingsbury Town 5762 34
Burial Date Cemetery,Crematory or Facility Name
10/30/2020 Pine View Crematorium
❑Entombment Address
X❑Cremation Queensbury Town,New York
Donation
Date Place Removed
Removal
and/or and/or Held
- Hold Address
0
d Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
l- Remains are Shipped,If Other than Above
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/30/2020 Registrar of Vital Statistics Cynthia ABard n(ECectronicalTySigned)
(signature)
District Number 5762 Place Kingsbury Town, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH Z Date of Disposition 1 13)tc Place of Disposition
W 1j
2 (address)
W
(section) At numper/ (grave number)
Name of Sexton or Person in Charge of Pre �"'"���
Z (please rind 111 Signature Title P
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b)
014154
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#