Marino, Mary Lou tt ;
NEW YORK STATE DEPARTMENT OF HEALTH .1.6.-- :
7. Z
Bureau of Vital Records Burial - Transit�Permit
Name First Middle Last Sex
Mary Lou Marino Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/24/2022 84 Years War or Dates
8. Place of Death Hospital,Institution or
City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
a Manner of Death II Natural Cause Accident Homicide DSuicide ❑Undetermined FIPending
NJ
0 Circumstances Investigation
WL I Medical Certifier Name Title
Joshua Started NP
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 10
Burial Date Cemetery,Crematory or Facility Name
03/29/2022 Pine View Crematory
_Entombment Address
Cremation Queensbury Town,New York
DDonation
ZEl Removal Date Place Removed
p and/or and/or Held
CO Hold Address
CO Transportation Date Point of
t
ES❑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
i , Remains are Shipped,If Other than Above
Address
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/29/2022 Registrar of Vital Statistics Shelley Mch.grnon(ECectronicalrySigned)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 3 J24)I L Place of Disposition -?MlL. /... Of+�
(address)
U1
(section) (lot number) (grace number)
Name of Sexton or Person in C e of Premises- '1 V IL -34 41 It
W ` lease print)
Si nature �—! .�� Title �fv�`411i1
g
DOH-1555(07/18)p 1 of 2
C 4 r^ 6�.
Public Health Law Sec. 4145(2b)
Receipt
Human remains of `ldelivered on , 20.
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#