Thomas, Mary -7-0 7
NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
Name First Middle Last Sex
Mary E. Thomas Female
Date of Death Age If Veteran of U.S. Armed Forces,
03 / 10 / 2017 72 War or Dates N/A
Place of Death Hospital, Institution or
ZCity, Town or Village Northumberland Street Address 44 Thomas Road
0 Manner of Death F Natural Cause E Accident 0 Homicide E Suicide Undetermined 7 Pending
Circumstances Investigation
tii Medical Certifier Name Title
CA Eric A. Pillemer MD
Address
102 Park St #3, Glens Falls, NY 12801
Death Certificate Filed District Nbf Register Number
iin City, Town or Village Northumberland `D 3
in Burial Date Cemetery or Crematory
03 / 10 / 2017 Pine View Crematory
Entombment Address
ECremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Hold Address
Date Point of
Q Transportation Shipment
La by Common Destination
Carrier
Disinterment Date Cemetery Address
iMi
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Sii Address
402 Maple Ave. , Saratoga Sp., NY 12866
iiiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
Ir
IILI _
?` Permission is hereby granted to dispose of the human remains described above as indicated.
S$ Date Issued C3\\- \\N\ Registrar of Vital Statistics `„..1 \i-\._
Atc------.
(signs re)
District Number y - p`)Place Northumberland , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 3/7/7 Place of Disposition J,71 jr ) 7'�Ln241
7
(address)
ihi
tr (section) (I t number) (grave number)
Ct :::t:e8
Charge of Premises &2 Title e_f-(2,_
(over)
DOH-1555 (02/2004)