Loading...
Caputo, Maryanne NEW YORK STATE DEPARTMENT OF HEALTH . `-'� 3� Vital Records Section Burial - Tra4sit Permit Name First Middle Last Sex Maryanne Caputo Female Date of Death Age If Veteran of U.S. Armed Forces, . April 18, 2016 75 War or Dates Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death Ran Natural Cause EjAccident ❑ Homicide ❑ Suicide 1-1 Undetermined Pending Circumstances Investigation LW Medical Certifier Name Title CI Agee!A. Gillani, M.D.', Address 102 Park Street, Glens Falls, New York 12801 Death Certificate Filed District Numbgrl� l Registerla, er City, Town or Village ��6.o / �( ❑Burial Date Cemetery or Crematory April 20, 2C Pine View Crematorium Entombment Address ©Cremation Quaker Road Que. ury,NY 12804 Date Place Removed z ❑ Removal and/or Held 0. and/or Address �E Hold CO Date Point of 11 ❑Transportation Shipment by Common Destination C Carrier y `.. - ❑ Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped, If Other than Above 2 Address CC Lu E" Permission is hereby granted to dispose of the human remains describve in ' Ar_____1. Date Issued DL//Z�I/2©/6- Registrar of Vital Statistics 12 /� / (signature) District Number 0j 60/ Place l L-S /-2v , ,' V I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t J; Date of Disposition 04/20/2016 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) W- 0) Ce (section) (lot number) (grave number) dName of Sexton or Person in Charge o Premises Irti+ipi, 1 d (please print) W' Signature Title t (over) DOH-1555 (02/2004)