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Marshall Sr., Francis Earl Roy 1°0F NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Francis Earl Roy Marshall Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 04/21/2021 81 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Ci Manner of Death Natural Cause Accident 0 Homicide 0 Suicide Undetermined ❑Pending W Circumstances Investigation U Ili Medical Certifier Name Title 0 Aaron Heckler PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 187 ©Burial Date Cemetery,Crematory or Facility Name 04/27/2021 Pine View Cemetery 0 Entombment Address ❑Cremation Queensbury Town,New York ❑Donation 0 Removal Date Place Removed and/or and/or Held N Hold Address 0 0. Date Point of to ❑Transportation Shipment p by Common Carrier Destination 0 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 W 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 04/22/2021 Registrar of Vital Statistics gg6ertAndrew Curtis(Electronically 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: W Date of Disposition 4/27/2021 Place of Disposition21 Quaker Rd Queensbury, NY 12804 (address) Erie 4 G 1 CC (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premises Connie Goedert Z (please print) uJ Signature Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012852 Receipt --s /0z;406i Human remains of ..• , • - delivered on , 20 Pine View Cemetery Representing the funeral home named,on burial permit Official Funeral Directors Reg.or License# MARSHALL SR. NAME Age: 8 Francis Earl Roy Marshall Sr Lot Owner:Francis $ Agnes Marshall Lot# Erie 4G Grave# Case: Concrete Died: 4/21 /2 0 21 Interred4/2 7/2 0 21 Funeral Home: Carleton FH Cemetery: Pine View