Richmond, Marlene Ann , /4- (#40
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Marlene Ann Richmond Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/01/2022 78 Years War or Dates
F.. Place of Death Hospital,Institution or
Z City,Town or Village Greenfield Town Street Address 325 Green Road,Greenfield Town,New York 12833
ILI
0 Manner of Death El Natural Cause Accident n Homicide Suicide Undetermined nPending
W ' f
V Circumstances Investigation
Clio Medical Certifier Name Title
Brigitte Bekan-Homawoo MD
Address
11 Hempstead Place 103,Saratoga Springs,New York 12866
Death Certificate Filed Town Of Greenfield District Number Register Number
City,Town or Village 4557 25
BurialEl
Date Cemetery,Crematory or Facility Name
08/03/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
H and/or and/or Held
N Hold Address
0
a Date Point of
en❑Transportation
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
f.. Remains are Shipped,If Other than Above
S Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/03/2022 Registrar of Vital Statistics Karen S.Dowen(Electronically Signed)
(signature)
District Number 4557 Place Town Of Greenfield
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-
Z Date of Disposition g�ZoZL Place of Disposition T:Ak2_ (4 env 4'rei 1, p f
2 (addres
'Li
CC (section) (lot number) (grave number)
464 0 Name of Sexton or Person in Charge remi s � a i/t� dot,
Z (please print/
W Signature ` Title p.'1
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
. t
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#