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Marcille, Richard A ' (:::1„7":_t st t 10 NEW YORK STATE DEPARTMENT OF HEALTH Bu rial of Vital Records - Transit Permit Name First Middle Last Sex Richard A.Marcille Male Date of Death Age If Veteran of U.S.Armed Forces, 08/10/2023 78 Years War or Dates t_ Place of Death Hospital,Institution or ILI Z City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing p Manner of Death J Natural Cause Accident El Homicide DSuicide []Undetermined ❑Pending W I I V Circumstances Investigation Q Medical Certifier Name Title Joshua Starteri NP Address 17 Madison St,Granville Village,New York 12832 Death Certificate Filed Village Of Granville District Number Register Number City,Town or Village 5725 33 BurialH Date Cemetery,Crematory or Facility Name 08/14/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York DDonation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 d Date Point of U)[]Transportation p by Common Shipment Carrier Destination oDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom _— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/14/2023 Registrar of Vital Statistics Diana Scarlotta(Electronically Signed) (signature) District Number 5725 Place Village Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 81t5- 1-1,3 Place of Disposition -KCL-, A-, 2 (address) W U) CC (section) /J (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises �// L., F Z (ple se print)W Signature Title fr/MwPt DOH-1555(o7/18)p tiff 2 1 7 8 Public Health Law Sec. 4145(2b) Receipt Human remains of k ` • " delivered on , 20 Pine View Cemetery — Repkettityl a the funeral home named on buria pt � Official Funeral Directors • or License# i