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Koenig, Marie Birdie NEWYORKSTATEDEPARTMENTOFHEALTH 41111111, # ssq Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marie Birdie Koenig Female Date of Death Age If Veteran of U.S.Armed Fortes, 07/09/2023 91 Years War or Dates l~ Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 7 Pollazzo Court,Queensbury Town,New York 12804 p Manner of Death El Natural Cause Accident Homicide Suicide illUndetermined Pending ✓ Circumstances Investigation 0 Medical Certifier Name Title Sean Campanie NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 108 Burial Date Cemetery,Crematory or Facility Name 07/11/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held F Hold Address N 0 0- Date Point of Cl) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom f- Remains are Shipped,If Other than Above N Address IZ 11J a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/11/2023 Registrar of Vital Statistics Carolinex/Gegard Barrier(/ctronicatySignerl) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:F. � Z7112,173 �� / W Date of Disposition Place of Disposition L-U- ll�l 2 (ad ess) W Cl) (section) (lot number) (grave number) GName of Sexton or Person in Charge of e .ses Z (pl e print) tL Signature Title _ V Oki 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#