Liucci, Josephine Gloria -# 3 z
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Josephine Gloria Liucci Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/07/2020 89 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Moreau Town Street Address 198 Bluebird Road,Moreau Town,New York 12803
`p Manner of Death ❑X Natural Cause ❑Accident Homicide Suicide ❑Undetermined Pending
V Circumstances Investigation
W Medical Certifier Name Title
Robert Love MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 19
Burial Date Cemetery,Crematory or Facility Name
04/08/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
H N Hold Address
O
G- Date Point of
CO) F1 Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home —701130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
Q
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/08/2020 Registrar of Vital Statistics CeeannMcca&(EkctronrcallySyved)
(signature)
District Number 4562 Place Moreau, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F— /f
Z Date of Disposition LO Place of Disposition
LLJ (address)
W
N (section) (lot number) (grave number)
Q
0 Name of Sexton or Person in Cha of Premises h i
Z (p ase print)
W Signature Title
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 3 5"."1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#