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Whitesel, mary B, NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary B.Whitesel I Female Date of Death Age If Veteran of U.S.Armed Forces, 05/11/2020 88 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Charlton Town Street Address 880 Charlton Road,Charlton Town,New York 12302 Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Patricia Stott NP Address 43 New Scotland Avenue MC7,Albany,New York 12203 Death Certificate Filed District Number Register Number City,Town or Village Charlton 4551 20-11 ©Burial Date Cemetery,Crematory or Facility Name - _ 05/16/2020 Pine View Cemetery _ ` Entombment Address Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held Hold Address Date Point of ❑Transportation Shipment by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Armer Funeral Home Inc 00094 Address 39 E High St,Ballston Spa,New York 12020 Name of Funeral Firm Making Disposition orto Whom Remains are Shipped,If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/13/2020 Registrar of Vital Statistics Brenda L Wids(ECectronicalTySiyned) /signature) District Number 4551 Place Charlton, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 5/1 6/2 0 2 0 Place of Disposition 21 Quaker R /address) Erie 39B 1 (section) (lot number) (grave number) Name of Sexton o Person in Charge of Premises Connie Goedert (please print) Signature Title Suiperintentent DOH-1555(07/18)p 1 of 2 1 Public Health Law Sec.4145(2b) 010381. Receipt Human remains of-- '�' ` l delivered on , 20 Pine View Cemetkry Representing the funeral home named on burial permit Official Funetal Directors Reg.or License# — i WHITESEL NAME MARY B. WHITESEL Age: 88 Lot Owner: FREDERICK & MARY B. WHITESEL Lot# ERIE 3 9B Grave# 1 Case: CONCRETE Died:5/1 1 /2020 Interred: 4/2020 Funeral Home: Armer Funeral Home INC. Cemetery: Pine View Cemetery