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Mullen, Marlene Joan .q.:LF) It 1.3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marlene Joan Mullen n_ .aM`, ,.. Female Date of Death Age If Veteran of U.S.Armed Forces, 12/30/2023 75 Years War or Dates i,,. Place of Death Hospital,Institution or Z City,Town or Village Kingsbury Town Street Address 29 Lori Avenue,Kingsbury Town,New York 12839 `p Manner of Death ❑X Natural Cause Accident Homicide Suicide ❑Undetermined Pending Circumstances Investigation {ULI Medical Certifier Name' Title C Paul Filion MD Address t, 3 Irongate Center,Glens Falls,New York 12801 'P.r Death Certificate Filed Town Of Kingsbury District Number Register Number City,Town or Village 5762 19 Burial Date Cemetery,Crematory or Facility Name 01/02/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York Donation ❑Removal Date Place Removed • and/or and/or Held F- Hold Address N 0 O. Date Point of Cl) Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 1— Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/02/2024 Registrar of Vital Statistics Cynthia Barcfin(ECectronica((y Signed) (signature) District Number 5762 Place Town Of Kingsbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition 1l H 123 Place of Disposition F.TNb✓iF:J ie6+►I,Q-RQ"_ 2 (address) W N CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charm of Premises (A r• \ Scn'[h z lease print) W Signature Title fib DOH-1555(07/18)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#