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Zwick, Marilyn Ann (2)
>3C93 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marilyn Ann Zwick Female Date of Death Age If Veteran of U.S.Armed Forces, 12/25/2020 89 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 15 Stewart Ave,Glens Falls,New York 12801 p Manner of Death © Natural Cause Accident ❑Homicide ElSuicide ❑Undetermined Pending IJJ V Circumstances Investigation W Medical Certifier Name Title a Aimee Mcmaster Nurse Practitioner,Acute Care Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 601 ▪Burial Date Cemetery,Crematory or Facility Name 12/30/2020 Pine View Cemetery ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation z Removal Date Place Removed and/or and/or Held N Hold Address CO ❑Transportation Date Point of S by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/30/2020 Registrar of Vital Statistics W96ert Andrew Curtis(ECectronicat(y Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:: Date of Disposition / .Z-3/-7?.(J Place of Disposition �;y, je,J F`ye t yt a/v/ IJJ (address W (I) (sect/on) i (lot number) (grave number) Name of Sexton or Pers'• in C rge of Premises 11J (please print/ Signature Title (✓ �' �'Z't" I DOH-1555(018) •4 of 2 Public Health Law Sec. 4145(2b) 0 14 354 Receipt Human remains of delivered on , 20 fF . Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#