Cook, Mary M. NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary M. Cook Female
Date of Death Age If Veteran of U.S. Armed Forces,
02 / 14 / 2020 64 War or Dates N/A
Place of Death Hospital, Institution or
City, Town or Village Greenfield Street Address
W 318 Wing Road
a Manner of Death®Natural Cause 0 Accident Homicide Suicide ❑Undetermined Pending
lu
Circumstances Investigation
Medical Certifier Name Title
John Mongan DO
Address
3 Care Ln #300, Saratoga Springs, NY 12866
Death Certificate Filed District Njumber Register Number
City, Town or Village GreenfieldSS
Burial Date Cemetery or Crematory
02 / 18 / 2020 Pine View Crematory
Entombment Address
®x Cremation Queensbury, NY
Date Place Removed
.�Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby ranted to dispose of the human rem in descr' ed above asjndicated.
Date Issued otj Registrar of Vital Statistics
(signature)
District Number Place
Greenfield New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tJ Date of Disposition Z 40 Place of Disposition //�
(address)
(section) (lot number (grave number)
0.
a Name of Sexton or Person ip arge of Pre ses
(pl se pnn)
tu
Signature Title
(over)
DOH-1555 (02/2004)
Public Health Law Sec. 4145(2b) 013346 �
i
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# '