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Lewis, Marjorie NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marjorie Claire Lewis Female Date of Death Age If Veteran of U.S.Armed Forces, 01/26/2023 81 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital 'JJ p Manner of Death ❑X Natural Cause Accident El Homicide Suicide FlUndetermined ❑Pending C.) Circumstances Investigation IV Medical Certifier Name Title Spenser Vines DO Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 0243 ©Burial Date Cemetery,Crematory or Facility Name 02/03/2023 Pine View Cemetery II Entombment Address Cremation Queensbury,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H N Hold Address V1 Transportation Date Point of LB by Common Shipment Carrier Destination ODisinterment 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 Remains are Shipped,If Other than Above 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/30/2023 Registrar of Vital Statistics Daniel&e S Gillespie(Electronically Signed) (signature) District Number 0101 Place City Of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H w Date of Disposition ��Ji Place of Disposition c ( iC� �Q� QL IRjl M I (address) (s . (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises Z (please print) W Signature a, Title -/.=:=TN J(*, DOH-1555(07/18)p 1 of 2 i Public Health Law Sec. 4145(2b) 012968 Receipt (7, s._....1:: _, Human remains of - _... -delivered on . ,, ...., , ___ , 20, , .. ,,. ._,, --:------13ine View'Cemetery — Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# LEWIS ti NAME Marjorie Lewis Age: 81 Lot Owner: Larry & Marjorie Lewis Lot# Erie 7D Grave# 2 Case: Concrete Died: 1 .2 6.2 3 Interred: 2.3 .2 3 Funeral Home: Regan Denny Stafford Cemetery: Pine View LEWIS Lot No. 7D Address Queensbury, NY 12804 Section No. Owner Larry & Marjorie Lewis Plot Eie A0626- s 44ti z I ASeg , 1,_1v lZSc- — //z9/v� Date 10/3/2011 Approx. 67 Superficial ft. Location Bounded on the North by Path, East by Eldred, West by Vacant and South by Vacant Corner Posts Remarks 636-5291 Deed No. (and changes) 3740 Payment Record Paid in full on 10/3/2011 ( $1 ,200. 00) Record of Interments v A C A i z e U 3 A A 4 C s A V)c ,; ELDRE.D w A S < �1 Form No. 01