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Peluso, Mary Elizabeth bC) NEW YORKSTATE DEPARTMENTOF HEALTH Burlap - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary Elizabeth Peluso Female Date of Death Age If Veteran of U.S.Armed Forces, 05/03/2020 96 Years War or Dates F. Place of Death Hospital,Institution or W City,Town or Village Mineola Village Street Address Winthrop University Hospital 'p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending V Circumstances Investigation Q Medical Certifier Name Title Seth Bender MD Address 259 1st Street,Mineola Village,New York 11501 Death Certificate Filed F2908 ict Number Register Number City,Town or Village Mineola Village 502 ❑Burial Date Cemetery,Crematory or Facility Name 05/07/2020 Pine View Crematory Entombment Address FRO Cremation Queensbury Hamlet,New York ❑Donation 0 ❑Removal Date Place Removed and/or and/or Held H asHold Address O d Date Point of N ❑Transportation 'p by Common Shipment Carrier Destination FjDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home NEW LEAF CREMATION 02058 Address 3930 LONG BEACH RD., ISLAND PARK, New York 11558 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W (L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/06/2020 Registrar of Vital Statistics WayneYfenry Wink(Efectronically Signer) (signature) District Number 2908 Place Mineola Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: P 3 ZOZO Place of Disposition 7Y)� �QW ( ,Yra, j W Date of Disposition .S-� W (addre ) W N Er (section) (lot number) (grave number) 8 Name of Sexton or Pe n in C rge of Premiss �u- i' �e- Z (please print) W Signature Title G� DOH-1555(07/18)p 1 dt 2 Public Health Law Sec. 4145(2b) 1013796 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#