Masher, Karol E. r �IgB
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Karol E.Masher Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/02/2020 70 Years War or Dates
�.., Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Mannerof Death ®Natural Cause Accident Homicide Suicide ❑Undetermined Pending
W Circumstances Investigation
WMedical Certifier Name Title
Kara Comins PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 103
Burial Date Cemetery,Crematory or Facility Name
03/03/2020 PineView Crematorium
Entombment Address
177 Cremation Queensbury Town,New York
Donation
Z ❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
t�
Off. Date Point of
W ❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Registration Number
Permit Issued to
Name of Funeral Home Mason Funeral Home 01117
Address
18 George St Po Box 277,Fort Ann,New York 12827-0277
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/03/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed)
(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:
WDate of Disposition Place of Disposition (address) r,u_
W
td (section) (lot number) (grave number)
Q
Name of Sexton or Person in Charge of Premises
Q (p/ se print/
Z`
W Signature ZT, Title
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 0 1 3 3
Receipt
Human remains of `�" �` , ,,1; :> % delivered on r` , 20
Pine View Cemetery Representing the funeral home named on burial permit
#Official Funeral Directors Reg.or License :' ,