Plude, Lois Marie Maryland Burial Transit Permit
This permit must accompany remains to destination
CERTIFICATE ID: 279891 BTP Number: 959809
1.Decedent's Name,AKA Name(d any) 2.Date of Death 3.Time of Death
LOIS MARIE PLUDE 04/11/2020 1950
4a.Facility Name 4b.City,Town or Location of Death 4c.County of Death
THE HERMITAGE AT SOLOMONS, 13325 DOWELL ROAD SOLOMONS CALVERT
5.Social Security Number 6.Sex 7.Age 8.Date of Birth 9.Birthplace
132221182 F 189 YR 05/15/1930 MASSACHUSETTS
10b.County 10c.City,Town or Location 10d.Inside City Limits?
10a.StateMARYLAND CALVERT SOLOMONS NO
10e.Address 13325 DOWELL ROAD 116 1 Of.Zip Code 20688
11. Marital Status 12.Ever in U.S. 13.Hispanic Origin? NO 14.Race
WIDOWED(AND NOT Armed Forces? WHITE
REMARRIED) NO
15.Decedent's Education 16a.Decedent's Usual Occupation 16b.Business/industry
HS OR GED BOOKKEEPER COMPUTER SOFTWARE
17. Father's Name 18.Mother's Name Prior to First Marriage
ALFRED A. MESSIER MARY LOUISE POULIOTTE
19.Surviving Spouse's Name
20a.Informant's Name 20b.Informant's Relationship 20c.Informant's Mailing Address
DOUGLAS J. PLUDE SON 2301 WILCHESTER GLEN DRIVE,VIRGINIA BEACH,VA 23456
21a.Method of Disposition 21b.Place of Disposition 21c.Date of Disposition 21d.Location
BURIAL, REMOVAL PINE VIEW CEMETERY LINK QUEENSBURY, NY
22a.Signature of Funeral Service Licensee 22b.License No 22c.Name and Address of Funeral Facility
MICHAEL KEVIN GARDINER,JR E:; :' M01133 RAUSCH FUNERAL HOME PA
20 AMERICAN LANE P O BOX 600, LUSBY,MD 20657
Authority for Burial,Transportation, Removal, Cremation or Other Disposition
This burial permit,when completely filled in and bearing below the signature of the attending physician and funeral director,constitutes authority for
burial,transportation,removal,cremation or other disposition of the deceased named above.Once burial or cremation takes place,the cemetery or
crematory authority must,within 10 days of burial/cremation,go to the following website to complete the burial/cremation record:
hftps:Hmdedrs.health.maryland.gov/burial
Please go to the website listed above to record the Burial/Crematory record.
Cemetery or Crematory Authority Shall Fill Out Section Below
The deceased named above was
0 buried
0 cremated
in the cemetery or crematory named in item 21 b.
Burial was in Section Lot Grave
Signature(Sexton or other person in charge) Date Signed
This burial transit permit must be signed above by the cemetery or crematory authority. Where there is no full-time person in charge of the cemetery,
the funeral director may sign as the sexton.If burial took place in Maryland,this permit must be returned within ten days to the:
Maryland Department of Health
Division of Vital Records
6764-B Reisterstown Road
Baltimore Maryland 21215
29a.Certifier Type 29b.Signature and Title of Certifier M1 29c.License No 29d.Date signed
CERTIFYING PHYSICIAN CHARLES M. BENNER, MD a ' D31563 04/13/2020
30a.Name of person who completed cause of death 30b.Address of person who completed cause of death
CHARLES M.BENNER 14090 HG TRUEMAN ROAD 2300,SOLOMONS, MD 20688
For Office Use Only:
31,Date Filed 32.Registrar at Filing 33.Date Issued 34.This is to certify that this is a true and correct copy of the official record on file in
the office of the Maryland Division of Vital Records.
Registrar's Signature
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on t , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
PLUDE
NAME Lois Marie Plude Age: 89
Lot Owner: David J. Plude
Lot# 2 6B #2 Hudson Grave# 2
Case: Concrete
Died: 4/1 1 /2 0 2 0 Interred:4/2 0/2 0 2 0
Funeral Home:
Carlentons
Cemetery:Pine View Cemetery