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Guilzio, Mary NEW YORK STATE DEPARTMENT OF HEALTH * sP Vital Records Section Burial - Transit_ Permit Name First Middle Last Sex ot z Mary Rose Gulizio • Female Date of Death Age If Veteran of U.S. Armed Forces, 11/14/2017 97 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Queensbury Town greet Address The Stanton Nursing And Rehabilitation Centre Manner of Death©Natural Cause ❑Accident Homicide ❑Suicide ❑Undetermined ❑Pending ` Circumstances Investigation ,;; Medical Certifier Name Title Bemardo Villajuan MD i' "s t Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Nu er Register Number e ] City, Town or Village Queensbury 5657 140 ❑Burial Date Cemetery or Crematory 11/16/2017 Pine View Crematory El Entombment Address a ®Cremation Queensbury Town, New York = :; Date Place Removed rl❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier -.,Q Disinterment Date Cemetery Address Date CemeteryAddress Reinterment ArA Permit Issued to Registration Number 4,1 Name of Funeral Home Maynard D Baker Funeral Home 01130 - {' Address 11 Lafayette St,Queensbury,New York 12804 Pa Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address ,r Permission is hereby granted to dispose of the human remains described above as indicated. " 4 Date Issued 11/16/2017 Registrar of Vital Statistics Carohne.1CBar6er aays�dt liji (signature) li District Number 5657 Place Queensbury, New York ell . I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition j/J Zl Ill Place of Disposition e,,ati✓ 4..00, 0, (address) (section) 4 (lot number) (grave number) Name of Sexton or Person in Charge of Pr-risesrutpl,� , �N.�l� (p ase print) Signature Title A F_flo A (over) DOH-1555 (02/2004)