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Ferber, Maryalice NEW YORK STATE DEPARTMENT OF HEALTH '' 4.41 /G-7 Vital Records Section Burial - Transit Permit it ' Name First Middle Last Sex Maryalice Ferber Female Date of Death Age If Veteran of U.S. Armed Forces, 09/19/2017 79 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre Manner of Death Undetermined Pending> �- ©Natural Cause El Accident ❑Homicide ❑Suicide ❑ ❑ Circumstances Investigation Medical Certifier Name Title Carrie Miron PA Address 152 Sherman Ave,Queensbury Town, New York 12801 — Death Certificate Filed District Number Register Number City, Town or Village Queensbury 5657 121 ['Burial Date Cemetery or Crematory 09/20/2017 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier Date Cemetery Address e❑Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 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 09/20/2017 Registrar of Vital Statistics carohne1fcBar6er 'lectronicallySigned .14 (signature) District Number 5657 Place Queensbury, New York - I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition if hi ill Place of Disposition fa,0,.•^/ `lvtl oriel,.., (address) • (section) / (lot number) S (grave number) Name of Sexton or Person in Charge o Premises hr3s� BM�R (pl ase print) Signature A 'p- Title nilMti32_ (over) DOH-1555 (02/2004)