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Taenzer, Mary NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Mary Taenzer Female Date of Death Age If Veteran of U.S. Armed Forces, 07/31/2018 80 Years War or Dates 11 Place of Death Hospital, Institution or WCity, Town or Village New City Hamlet Street Address Joe Raso Hospice Residence p Manner of Death©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title 0 David Chmielewski MD Address 415 Buena Vista Road,New City Hamlet,New York 10956 Death Certificate Filed District Number Register Number City, Town or Village New City 4350 353 ®Burial Date Cemetery or Crematory 08/08/2018 Seely Cemetery []Entombment Address []Cremation Queensbury Town, New York Date Place Removed 0❑Removal and/or Held 0 and/or Address N Hold 0 Date Point of NQ Transportation Shipment 70 by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home zygmunt-Murtie Funeral and Cremation Service 01986 Address 1525 Burlingham Road,Pine Bush,New York 12556 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/02/2018 Registrar of Vital Statistics Justin sweet(E(ectronicallyStgned (signature) District Number 4350 Place New City, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z p &YO-7 W Date of Dis ositionPlace of Disposition (ad ess) W (section) (lot number) (grave number) pName of Sexto Person in Charge of Premises Z (please print) W Signature Title (over) DOH-1555(02/2004)