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Discenza, Mia (2)
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit .._, I Name First Middle Last Sex Mia Marie Discenza Female Date of Death Age If Veteran of U.S. Armed Forces, I. September 8, 1966 8 MO War or Dates 2 Plac ath Hospital, Institution or W City, Town, or Village Queensbury, NY Street Address Orchard Drive G Manner o Death 0 Natural Cause ❑ Accident ❑ Homicide ❑Suicide ❑Undetermined ❑ Pending W Circumstances Investigation U Medical Certifier Name Title W Q Address di Death Certificate Filed District Number Register Number City, Town or Village Date Cemetery or Crematory E Burial Address [ I Cremation 2 Date Place Removed 0 ❑ Removal and/or Held F and/or Address Hold 0 Date Point of 0 ❑Transportation Shipment d by Common Destination 0 Carrier = Date Cemetery Address �I ^ ElDisinterment Nov. 1 7, 2008 St. Alphonsus Cemetery,Queensbury,NY ®Reinterment Date Cemetery Address Nov. 1 7, 2008 PineView Cemetery, Quaker Rd, Queensbury Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00283 Address F- 68 Main St., P. 0. Box 67, Hudson Falls, New York 12839 Name of Funeral Firm Making Disposition or to Whom a Remains are Shipped, If Other than Above w Address O. Permission is hereby granted to dispose of the human mains described above as indicated. Date Issued \ I I l `� 1 ©a Registrar of Vital Statistics r Q . (Le st___., (signature) District Number j(.- -3 Place / d, or C r,r, F I certify that the remains of the decedent identified above were disposed of in accorda " e w' h this permit on: W Date of Disposition Place of Disposition 2 (address) N 1 (section) (lot number) (grave number) 0 O Name of Sexton or Person in Charge of Premises W (please print) Signature Title , NEWYORK STATE DEPARTMENT OFHEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Mia Marie Discenza Female Date of Death Age If Veteran of U.S. Armed Forces, I- September 8, 1966 8 MO War or Dates Z Plac= _ !-ath Hospital, Institution or W City, Town, or Village Queensbury, NY Street Address Orchard Drive G Manner o Death 0 Natural Cause ❑ Accident ❑ Homicide ❑Suicide ❑ Undetermined ❑ Pending W Circumstances Investigation O Medical Certifier Name Title W Q Address Death Certificate Filed District Number Register Number City, Town or Village Date Cemetery or Crematory LI Burial Address [ I Cremation Z Date Place Removed 0 ❑ Removal and/or Held - and/or Address Hold 0 Date Point of 0 ❑Transportation Shipment d by Common Destination 0 Carrier Date Cemetery Address ® Disinterment Nov. 1 7 2 0 0 8 St. Alphonsus Cemetery,queensbury,Nv III Reinterment Date Cemetery Address Nov. 1 7, 2008 PineView Cemetery, Quaker Rd, Queensbury Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00283 Address H 68 Main St., P. 0. Box 67, Hudson Falls, New York 12839 Name of Funeral Firm Making Disposition or to Whom 8: Remains are Shipped, If Other than Above w Address O. Permission is hereby granted to dispose of the human r mains described above as ind(cated. i ( Date Issued 1 J ( ( a l ©s/Registrar of Vital Statistics �-�i n , rue A--. (signature) District Number j o Place b �� 0 �� F I certify that the remains of the decedent identified above were disposed of in accordan a wi h this permit on: 2 w Date of Disposition 11/17/08 Place of Disposition Pine View Cemetery 2 (address) O Mohican 1OF 1A 0 (section) (lot number) (grave number) d Name of Sexton or Person in Charge of Premises Michael Genier 2 (please print)w Title SuperintendentSignatur e91,4L...,-,