Duell, Mary lk 1 ---C7
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary E. Duell Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 16,2012 67 War or Dates
i.. Place of Death Hospital, Institution or
Z City, Town or Village thurman I Street Address 21 Mountain Road
Manner of Death 1 Xi Natural Cause I I Accident Homicide I I Suicide Undetermined I 1 Pending
Circumstances Investigation
W Medical Certifier Name Title
G Brun Smead _
Address
Bolton Health Center,Bolton Landing,NY 12814
Death Certificate Filed District Number Register Number
City, Town or Village Thurman 5659
El Burial Date Cemetery or Crematory
El
Entombment March 20,2012 Pine View Crematory
Address
El Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z
f I Removal and/or Held
and/or Address
L Hold
O Date Point of
Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
N Remains are Shipped, If Other than Above
• Address
tit
Permission is her;7? g anted to dispose of the human r ins described a v a indicat
Date Issued Registrar of Vital Statistics _ -',p<.,, t
(signature)
District Number 5659 Place Thurman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 3 a. Place of Disposition f eleV i'eW Cr-e,vi '(or ' 'wi
(address)
111
O (lot number) (grave number)
p Name of Sexton or Person in Charge of Premises t yvt dtky etu ru k
Z ��ii (please print)
W 9 .�l 4 �,�h Title C f e.r L&4or y aSI
Si nature //
(over)
DOH-1555 (02/2004)