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Starling, Marilyn Ann NEW YORKSTATE DEPARTMENT OF HEALTH • Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marilyn Ann Starling Female Date of Death Age If Veteran of U.S.Armed Forces, 01/17/2021 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address 325 Broadway 24, Fort Edward Town, New York 12828 W p Manner of Death © Natural Cause El Accident Homicide Suicide Undetermined Pending W U Circumstances Investigation W Medical Certifier Name Title Thomas Coppens MD Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 ❑Burial Date Cemetery,Crematory or Facility Name 01/19/2021 Pine View Crematory Entombment Address lCremation Queensbury Town, New York ❑Donation Z Removal Date Place Removed and/or and/or Held F Hold Address N 0 0• Date Point of U) ❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/19/2021 Registrar of Vital Statistics Aimee L Mahoney(Electronically Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition (I rl /Z( Place of Disposition ��L da+— W address) 2 (section) (lot number) (grave number) G Name of Sexton or Person in Charge of Pre es Z (ple e print) W Signature Title A -1(0W2 DOH-1555(07/18)p 1 of 2 y a Public Health Law Sec. 4145(2b) 014428 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#