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Creath, Mary Louise 7,3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Lag Sex Mary Louise Creath Female Date of Death Age If Veteran of U.S Armed Forces, 01/06/2020 85 Years War or Dates Place of Death Hospital,Institution or Z W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending (Wj Circumstances Investigation WG Medical Certifier Name Title Stephen Perazzelli MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Villa a Glens Falls 75601 13 ❑Burial Date Cemetery,Crematory or Facility Name 01/07/2020 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,Warren,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 tom/) ❑Transportation Date Point of a by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Otherthan Above Address IIE a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/07/2020 Registrar of Vital Statistics �RqbertAndirew Curds(ECectronicaffySiyned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F ' Z Date of Disposition 111170 Place of Disposition t:.. W 2 (address) W w (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises dir'IML had z (4se print) W Signature Title DOH-i555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 3 by d Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#