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Reeves, Marilyn L it ?i 7 NEW YORKSTATE DEPARTMENT OF HEALTH ��..-it--- Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marilyn L Reeves Female Date of Death Age If Veteran of U.S.Armed Forces, 03/20/2023 92 Years War or Dates i,., Place of Death Hospital,Institution or Z City,Town or Village Malta Town Street Address 26 Rockrose Way,Malta Town,New York 12020 ILI 0 Manner of Death Undetermined Pending UJ Natural Cause Accident Homicide Suicide U Circumstances Investigation W Medical Certifier Name Title CI Madison Zuis """'.. NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Malta District Number Register Number City,Town or Village 4560 21 Burial Date Cemetery,Crematory or Facility Name 03/21/2023 Pine View Crematory Entombment Address .��_ ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of Cl)ETransportation Shipment 5 by Common Carrier Destination Disinterment Date Cemetery Address 0 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 F. Remains are Shipped,If Other than Above 2 Address Q. W 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/21/2023 Registrar of Vital Statistics Jennifer Marie jlolmes(ECectronicaltySigned) (signature) District Number 4560 Place Town Of Malta I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: z . �L. Litz_ W Date of Disposition 3 iz z(1,; Place of Disposition iK (address) W CC ( ion) (lot number) (grave number) Name of Sexton or Person in Charge of Premises ) 4.-se print/ MI Signature Title `L DOH-1555(07/18)p id 2 Public Health Law Sec. 4145(2b) 1 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#