Upton, Marguerite B .'' '-.:-F): ,
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Marguerite B Upton Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/13/2022 67 Years War or Dates
1„_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
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p Manner of Death El Natural Cause ❑Accident Homicide Suicide Undetermined ❑Pending
V Circumstances Investigation
C Medical Certifier Name Title
Kelly Maley PA
Address
100 Park St.Glens Falls,New York 12801
Death Certificate Filed city Of Gans Falls District Number Register Number
Vi lla$e
0 5601 422
Burial Date Cemetery,Crematory or Facility Name
Addre2022 Plneview Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
0❑Removal Date . Place Removed
i= and/or and/or Held
N Hold Address
0
O. Date Point of
CO❑Transportation
b by Common _ Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
a Address
Ir
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O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/15/2022 Registrar of Vital Statistics Megan Yam(2;'iscttnmc' Signa4
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH
Z Date of Disposition gIis i it_ Place of Disposition fA.1(
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a dress)
W
CO
CC (section) 4 ,_ (lot numbe (grave number)
SName of Sexton or Person in C e of Premises M 1
Z (please print)
W C E� Crikt 1,1 .Ce
Signature Title
DOH 1555(o7/18)p 1 of 2
- a w} * ,vu
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#