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Mumblo, Margery Mary NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margery Mary Mumblo 7 Female Date of Death Age If Veteran of U.S.Armed Forces, 05/01/2020 96 Years War or Dates ii Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre WW Mannerof Death ©Natural Cause Accident Homicide ❑Suicide Undetermined Pending V Circumstances Investigation WW Medical Certifier Name Title Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed F5657 ict Number Register Number City,Town or Village Queensbury 88 Burial Date Cemetery,Crematory or Facility Name ❑ 05/01/2020 Pine View Cremation Entombment Address RI Cremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held N Hold Address O n- Date Point of 0 ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67, Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F.: Remains are Shipped,If Other than Above g Address cr W G' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/01/2020 Registrar of Vital Statistics CaroCineOildegardeBar6er(ECectronicaCCySigned) /signature/ District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- Z Date of Disposition -�40 Z-O Place of Disposition W 2 (address) W N � /section/ 11 9,e-,yn number/ /grave number/ Name of Sexton or Person in a emi s NH' �� �� (please print) Lu Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) J 13 S Receipt Human remains of ! delivered on , 20 i Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# `'