Mannino, Mary .- At 7 3�
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mary Mannino _ Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/11/2020 63 Years War or Dates
Z Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death a Natural Cause Accident Homicide Suicide Undetermined Pending
W _ Circumstances Investigation
U
WQ Medical Certifier Name Title
William Cleaver _ _ MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number �Reg�iisterNumber
City,Town or Village Glens Falls 5601
Burial Date Cemetery,Crematory or Facility Name
03/12/2020 Pineview Crematorium
Entombment Address
FRICremation Queensbury Town,New York
Donation
---T
Removal Date Place Removed
p, and/or and/o r Held
N Hold Address
O
d Date Point of
RnElTransportation
p by Common Shipment
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
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/12/2020 Registrar of Vital Statistics W-oAertf?rufrew Curtis(EYectronica11y,5'igned)
(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:
W Date of Disposition M 0116 Place of Disposition L.
2 (address)
W
N
(section) (lot Snumber) (grave number)
aName of Sexton or Person in Charge of Pr mises M `—
Z (pNase print)
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 13 4 2 6
Receipt
Human remains of delivered on , 20
i
Pine View Cem ery Representing the funeral home named on burial,permit
Official Funeral Directors Reg.or License# %j