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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)