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Del Bove, Mary NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit fr' Name First Middle Last Sex Mary Del Bove Female ,14 r Date of Death Age If Veteran of U.S. Armed Forces, '�r> May 13, 2017 95 War or Dates ' Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address The Pines Of Glens Falls Manner of Death X Natural Cause Accident n Homicide I 1 Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title t� Gwendolyn Dickinson,PA Address ISQueensbury,NY �t:` tf "F Death Certificate Filed District Number Register NupZber ` f City, Town or Village Glens Falls, NY 5601 ❑Burial Date Cemetery or Crematory May 16, 2017 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed ZZ n Removal and/or Held and/or Address H Hold Cl) O Date Point of Nri Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address ri Renterment Date Cemetery Address r,= P• ermit Issued to Registration Number N• ame of Funeral Home Singleton Sullivan Potter Funeral Home 01596 A• ddress 407 Bay Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom 1Remains are Shipped, If Other than Above Address >='' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued Sii 6 i i 7 Registrar of Vital Statistics V.1 C1'.A) `Q, `r,t6 (signature) ' District Number 5 ( Place 6 s ca \c, k9 7 O f I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z f �1 � W Date of Disposition Sn In 1 1 /Place of Disposition 1744 L,+,�.ghuty W (address) CO CZ (section) t/, (lot number) (grave number) pp• Name of Sexton or Person in Charge of Premises /4f.s A, Svwnttr Z (ple se print) W Signature Zi 2. Title ( 'E it iin_ (over) DOH-1555(02/2004)