Ocha, Mary NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary Ocha Female
Date of Death Age If Veteran of U.S. Armed Forces,
' January 17, 2013 89 War or Dates
"' Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 7 Morton Street
Manner of Deathr� Undetermined Pendin
I I Natural Cause n Accident n Homicide �Suicide � n 9
Circumstances Investigation
41 Medical Certifier Name Title
' ,, Richard Evans,MD
Address
Irongate,Glens Falls,NY 12801
i'/" Death Certificate Filed Glens Falls District Number Register Number
n City, Town or Village 5601
N Burial Date Cemetery or Crematory
❑Entombment January 21, 2013 Pine View Cemetery
Address
❑Cremation Quaker Road, Queensbury,,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
E Hold
cn
aDate Point of
N n Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
• s Name of Funeral Home Regan& Denny Stafford Funeral Home 01443
Address
' 53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
tit
Permission is h re y granted to dispose of the human mains described a ve as indic ted.
Date Issued Registrar of Vital Statistics -a y�--i
(signature)
District Number 601 Place Glens Falls
I certify that the remains of the decedent identified above ere disposed of in accordance with this permit on:
W Date of Disposition 1 /21 /1 3 Place of Disposition Pine View Cemetery
W (address)
Mohawk 98 1
rt
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Michael Genier
iu
Z (please print)
Signature 9jTitle Superintendent
(over)
DOH-1555(02/2004)