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Schiappa, Gloria E. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gloria E.Schiappa Female Date of Death Age If Veteran of U.S.Armed Forces, _`' 10/16/2020 98 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 102 Lake Avenue,Warrensburg Town,New York 12885 pManner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide ❑Undetermined ❑Pending Circumstances Investigation In Medical Certifier Name Title Suzanne Bergin DO Address 9 Carey Road,Queensbury Town, New York 12804 lel Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 26 ❑Burial Date Cemetery,Crematory or Facility Name 10/21/2020 Pine View Crematroy ❑Entombment Address F,EU Cremation Queensbury Town,New York ;,❑Donation z ❑Removal Date Place Removed and/or and/or Held f- Hold Address N 0 CL Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address ti` 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above 2 Address C W CI- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/20/2020 Registrar of Vital Statistics Pame(a MG(oyd(E(ectronicaltySigned) (signature) District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this ermit on: I-; / Date of Disposition ID III f 10 Place of Disposition I*a L,L.. �-o"`••• .. 2 (address) W CC (section) / of number) (grave number) 0' Name of Sexton or Person in Charge of P mises G j1f+. 1, SN.4.4Ii1 Z (plea print) W Signature Title 444110e DOH-1555(07/i8)p 1 of 2 Public Health Law Sec. 4145(2b) A413,3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#