Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Lucia, Maria
NEW YORK STATE DEPARTMENT OF HEALTH ,E NT Vital Records Section Burial - 1 r nit Permit 3is ag a Name First Middle Last Sex ?: Maria Luisa Lucia Female Date of Death Age If Veteran of U.S. Armed Forces, ` s May 5,2016 61 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death n Natural Cause I I Accident Homicide Suicide Undetermined Pending Circumstances Investigation _ �s Medical Certifier Name Title %i Address `::::;:i ,Glens Falls,NY 12801 Death Certificate Filed District Number Register Numb City, Town or Village Glens Falls 5601 ❑Burial Date Cemetery or Crematory May 6,2016 Pine View Crematory ❑Entombment Address ❑x Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed ZZ I I Removal and/or Held 2 and/or Address I_- Hold N O Date Point of EL Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address 1-7 Reinterment Date Cemetery Address 15q*a Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 Address i:il 3809 Main Street,Warrensburg,NY 12885 N• ame of Funeral Firm Making Disposition or to Whom R• emains are Shipped, If Other than Above a. Address u Permission is hereby granted to dispose of the human remains desc ibed boy as i��1 c•ted. sA ,�� Date Issued Dc��C�2©l6 Registrar of Vital Statistics � � (signature) District Number SO/ Place cle A Aiy „..., I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- t[ W Date of Disposition 7 '9 NI Place of Disposition ?pi �rt Uv ( r� E (address) W: U) 0 (section) 4,lot umber) J (grave number) pName of Sexton or Person in Charge of Pre ises ..�t 2 (plehse print) W` Signature at Title IL. (over) DOH-1555 (02/2004)