Hughto, Marion T j.F) 14 11
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Female
Marion T Hughto
Date of Death Age If Veteran of U.S.Armed Forces,
06/12/2022 90 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 70 Feeder Dam Road,Moreau Town,New York 12803
W Mannerof Death Undetermined Pending
'p Natural Cause Accident Homicide Suicide Circumstances Investigation
V Title
0LIJ Medical Certifier Name
Glen Anderson PA
• Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Moreau District Number Register Number
�
City,Town or Village 4562
Burial Date Cemetery,Crematory or Facility Name
06/15/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
Date Place Removed
ZO❑Removal and/or Held
F- and/or
(D
Hold Address
0
Date Point of
CO❑Transportation Shipment
p by Common Carrier Destination
Disinterment
Date Cemetery Address
LI Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
2 Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/15/2022 Registrar of Vital Statistics Geeann We cafe(E(ectronica1Ty Signed)
(signature)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1-
Z Date of Disposition �p-45-,,�j,Z Place of Disposition ,je 0 ir€„J Lrei1ia�D!`�
W (address)
W
N Cr (section) of num r) (grave number)
,/
gName of Sexton or Person in Charg f Pre is /4 �aa> t
z
7------- (please print)
W Signature 1---- Title of-esdc'fb
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) ,'". '; .�
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#