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Bavaro, Rose Marie NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Rose Marie Bavaro Female Date of Death Age If Veteran of U.S.Armed Forces, 12/10/2019 87 Years War or Dates Place of Death Hospital,Institution or NW City,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending UJI Circumstances Investigation W Medical Certifier Name Title D Michael Miles MD Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed FDistrict Number Register Number City,Town or Village Queensbury 15657 184 ❑Burial Date Cemetery,Crematory or Facility Name 12/12/2019 Pineview Crematorium ❑Entombment Address Cremation Queensbury Town,New York ❑Donation 0 Removal Date Place Removed and/or and/or Held F—N Hold Address O R Date Point of W Transportation Shipment 13 by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Radloff Funeral Home Inc 01425 Address 136 Warren St,Glens Falls,New York 12801 Name of Funeral Firm Making Disposition or to Whom f. Remains are Shipped,If Other than Above Address Q 11J CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/12/2019 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed) (signature/ District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /1 WDate of Disposition Ill(3 i Place of Disposition ( ti-- ,U /address/ W (section) (lot number/ (grave number/ gName of Sexton or Person in Charge of Premises (36Le- Z h (Pi seprint/ WSignature Title CKV^A M DOH-1555(o7/18)p 1 of 2 1 Public Health Law Sec. 4145(2b) Receipt Human remains of. t. delivered on 20 � Pine View Cemetery Representing the funeral home named on burial Permit f Official Funeral Directors Reg.or License# !