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Longden, Marion Elizabeth Z33 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marion Elizabeth Longden Female Date of Death Age If Veteran of U.S.Armed Forces, 02/27/2021 86 Years War or Dates F_ Place of Death Hospital,Institution or W City,Town or Village Fort Edward Village Street Address 37 Center Street, Fort Edward Village, New York 12828 ta Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ElUndetermined 0 Pending ILI .0 Circumstances Investigation W Medical Certifier Name Title 10 Thomas Kandora MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 14 Burial Date Cemetery,Crematory or Facility Name 03/02/2021 Pine View Crematory EiEntombment Address ElCremation Queensbury Town,New York Donation go Removal Date Place Removed and/or and/or Held ~N Hold Address 0 0. Date Point of (I) ❑Transportation p 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-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped,If Other than Above 2 Address Cr W 0' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/02/2021 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 ' 7 tZU Date of Disposition 31 Z f 7 1 Place of Disposition -IL _ 2 (address) W CC N (section) (lot number) (grave number) g Name of Sexton or Person in Charge of Premises 2 ` v P.(IPA 41 Z (please print) W Signature C Z. Title 74'" h: DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 1 1 1 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1