Hodgkins, Mary # VO 7
NEW YORK STATE DEPARTMENT OF HEALTH ,•Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary Caroline Hodgkins Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 25, 2017 88 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 16 Holly Lane
• Manner of Death Natural Cause n Accident ❑Homicide n Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Christopher Buff M.D.
'}'��h Address
1Scotia,New York 11.301
k<}' Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657
❑Burial Date Cemetery or Crematory
❑Entombment May26, 2017 Pine View Crematory
Address
❑x Cremation Quaker Road, Queensbury
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
35 n Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Renterment Date Cemetery Address
. Permit Issued to Registration Number
Name of Funeral Home Griswold Funeral Home 00694
g . Address
yr
1867 State Street, Schenectady, NY 12304
h s 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 describe above as indicated.
:r�{�f Date Is ued / Registrar of Vital Statistics .--�{ _
�'��ft�•: S/, - i� --i -, C__.
(signature)
r District Number he ) Place ` / O l� Cr( ( t;,__q�.e.
A
I certify that the remains of the decedent identified above were disposed of in a cordan e with this permit on:
LuDate of Disposition SXj 0 Place of Disposition erntl!•c-d (Tomta�',b�,
W (address)
Cl)
O (section) (lot n tuber) (grave number)
Q i Name of Sexton or Person in Charge of Premises 4•,i Jv Jt-
IZ /3 (ple se print)
Signature -I TitleE.1411
(over)
DOH-1555(02/2004)