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Dow, Marion Genevieve r In NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marion Genevieve Dow Female Date of Death Age If Veteran of U.S.Armed Forces, 10/17/2021 88 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital LU p Manner of Death © Natural Cause ❑Accident ❑ Homicide ❑Suicide ❑Undetermined ❑Pending 11.1 U 0 Circumstances Investigation Wp Medical Certifier Name Title Stephen Perazzelli MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 596 ❑Burial Date Cemetery,Crematory or Facility Name 10/19/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation 0 El Removal Date Place Removed and/or and/or Held Hold Address 0 N ❑Transportation Date Point of by Common Shipment Carrier Destination El 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 n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/19/2021 Registrar of Vital Statistics John Pau('Franck(E(ectronica((y Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition JG 11i I li Place of Disposition ! r l r W (address) W N (section) (lot number) (grave number) Name of Sexton or Person in Charge of ' mises r t ��"�� Z (lease print/ �} W Signature A Title DOH-1555(07/18)p 1 of 2 0' 5238 Public Health Law Sec. 4145(2b) Receipt Human remains of "" delivered on , 20 Pine View Cemetery Representing the fu>eral home named on burial permit Official Funeral Directors Reg.or License# -