Hamelin, Mary NEW YORK STATE DEPARTMENT OF HEALTH Ti. `11
Vital Records Section Burial - Transit Permit
Name First Middle Last j Sex
Mary C Hamelin I Female
Date of Death I Age If Veteran of U.S. Armed Forces,
September 23, 2011 90 War or Dates
t,.. Place of Death ( Hospital, Institution or
Z City, Town or Village Greenfield, NY ! Street Address 114 Saratoga Blvd
0 Manner of Death X Natural Cause Accident I J Homicide Suicide Undetermined J Pending
Circumstances Investigation
W, Medical Certifier Name Title
0 Dr John Koella,MD
Address
Saratoga Springs,NY
Death Certificate Filed District Number ! Register Number
City, Town or Village Greenfield,NY
El Burial Date Cemetery or Crematory
❑Entombment September 28, 2011 Pine View Crematory
Address
El Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal j and/or Held
O and/or Address
N Hold
co
O Date Point of
NI !Transportation Shipment
`p by Common Destination —"
Carrier
I I Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to j Registration Number
Name of Funeral Home Singleton-Healy Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
!-- Remains are Shipped, If Other than Above
E Address
CZ
O.
Permission is hereby granted to dispose of the human remains described above as indicated.g
Date Issued Registrar of Vital Statistics .p;
(signature)
District Number 4._( -5'`7 Place Greenfield,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition O I30 III Place of Disposition Pi„ U ttw Crier-e4irtv".
W (address)
co
ZY
(section) lot number) (grave number)
p Name of Sexton or Person in Charge o Premises rs r- Saxi�
Z please print)
WJ4 Signature Title attr At Oft—
(over)
DOH-1555(02/2004)