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Bogle, Maria J 1Z00 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marla J Bogle Female Date of Death Age If Veteran of U.S.Armed Forces, 11/30/2020 71 Years War or Dates F.. Place of Death Hospital,Institution or Z City,Town or Village Hadley Town Street Address 62 Rollman Circle,Hadley Town,New York 12835 W Manner of Death Undetermined Pending W ©Natural Cause Accident Ei Homicide Suicide U Circumstances Investigation Medical Certifier Name Title Amy Johnson PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Hadley 4558 16 ElBurial Date Cemetery,Crematory or Facility Name 12/02/2020 Pineview Crematory ❑Entombment Address Cremation Queensbury Town,New York 0 Donation Z Removal Date Place Removed - and/or and/or Held H- Hold Address N 0 G- Date Point of U) ❑Transportation p by Common Shipment Carrier Destination El Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above `J Address Q W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/01/2020 Registrar of Vital Statistics Pauline G Smead(Electronically Signed) (signature) District Number 4558 Place Hadley, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition I 2 Z I'ja Place of Disposition W ddress) W NCC (section) 4(lot number) (grave number) ft 0 Name of Sexton or Person in Charge of Premises C" L���� Z (plea e print) W11/ Title C q-��, Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014 % Receipt Human remains of ('+ delivered on c: , 20 } Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ! ` _