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Gill, Marion 4- 1793 NEW YORK STATE DEPARTMENT OF HEALTH -" = ' Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marion Gill Female Date of Death Age If Veteran of U.S.Armed Forces, 11/24/2020 91 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Stony Creek Town Street Address 50 Roaring Branch Road,Stony Creek Town,New York 12878 `p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined ❑Pending U Circumstances Investigation WW Medical Certifier Name Title Suzanne Bergin DO Address 3767 Main Street,Warrensburg Town, New York 12885 Death Certificate Filed District Number Register Number City,Town or Village Stony Creek 5658 6 ❑Burial Date Cemetery,Crematory or Facility Name 11/25/2020 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York 0 Donation o ❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 a 1-1 Date Point of t/) U Transportation p by Common Shipment Carrier Destination Date Cemetery Address 0 Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above „t Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/25/2020 Registrar of Vital Statistics Susan I Harrington(Electronically Signed) (signature) District Number 5658 Place Stony Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition II/27 f 7d Place of Disposition e` 2 address/ W tC CC (section) (lot number) (grave number) � • Name of Sexton or Person in Charge Premises iillease print/ ,�p W Signature Title !MAI , DOH-1555(07/18)p 1 of 2 1 Public Health Law Sec. 4145(2b) Receipt i Human remains of delivered on , 20_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#