Mara, Joseph .0 301
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial Transit Permit
ix: Name First Middle Last Sex
''::' Joseph f: P J. Mara male
:: Date of Death Age If Veteran of U.S. Armed Forces,
rf: 04/10/2018 56 War or Dates n/a
Place of Death Hospital, Institution or
:j City, Town or Village Glens Falls Street Address 91 Prospect Street
ti Manner of Death Natural Cause Accident n Homicide U Suicide X Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
;e.1; Ryan Donnelly, MD
Address
}r. 161 Carey Road Queensbury New York 12804
yf- Death Certificate Filed District Number Register Numb7.8.2
: City, Town or Village 04/12/2018 r) I
<' ❑Burial Date Cemetery or Crematory
04/12/2018 Pine View Crematory
❑Entombment Address
r IN Cremation Quaker Road Queensbury, NY 12804
Date Place Removed
Z E Removal and/or Held
and/or Address
Hold
N
0 Date Point of
NTransportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
tir Name of Funeral Home Regan Denny Stafford Funeral Home 01443
:f Address
53 Quaker Road Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to 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 4 II 2,1 2F)t%' Registrar of Vital Statistics (_k 4 s LA)..A
)
r. (signatu
.,� District Number 5 601 Place 6 LRAr S Vet 1 I S Al V
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
!J Date of Disposition '/f f3. Place of Disposition 'Kt U_4" 4, 1,
W" 4�1���Q (address)
N
CL (section) r (lot number) (grave number)
QName of Sexton or Person in Charge of Premises �.,, (., „ 4
Z //� ()lease print)
ILI
Signature Gif Title (RF.A►if Z
(over)
DOH-1555(02/2004)