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Smith, Marion Gayle
Z(23 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marion Gayle Smith Female Date of Death Age If Veteran of U.S.Armed Forces, 03/07/2021 81 Years War or Dates F Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing `Q Manner of Death, ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined Pending Circumstances Investigation Ui Medical Certifier Name Title CI Wendy Steinhacker PA Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 63 1-1 Burial Date Cemetery,Crematory or Facility Name 03/11/2021 Pine View Crematorium ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held F_- Hold Address N 0 d Date Point of Cl) ❑Transportation 'C) by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom ▪ Remains are Shipped,If Other than Above 2 Address CC LU a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/08/2021 Registrar of Vital Statistics Caroline (legartle Barber(ECectronicallySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition �j�/2-�j Z/ Place of Disposition �?�j t�Ut�L,4../ Lgkrterh,y 2 (address)/ 11J toCC (section) number/ (grave number) Name of Sexton or P n i harge of Premises V- /s 4-✓i CMG-rf Q.C.Lt-L (please print) LU Signature Title e e v�4z,alc �1J � e' DOH-1555(07/1 p 1 of 2 Public Health Law Sec. 4145(2b) 3•, 014631 Receipt Human remains of t; ° delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# is Health Law Sec. 4145(2b)