Getz, Mary -D._D--
NEW YORK STATE DEPARTMENT OF HEALTH
4 a
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
j: Mary Ella Getz Female
ti;
r:: Date of Death Age If Veteran of U.S. Armed Forces,
c s August 10, 2014 58 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 9 Platt Street
E Manner of Death IXl Natural Cause I. I Accident Homicide Suicide rI Undetermined Pending
Circumstances Investigation
ENMedical Certifier Name Title
Mark Hoffman,MD
rf�E Address
:i, Glens Falls,NY
ti%f Death Certificate Filed District Number Regis4ember
City, Town or Village Glens Falls,NY 5601 j L,,
❑Burial Date Cemetery or Crematory
August 12, 2014 Pine View Crematorium
❑Entombment Address
Li Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ ( 'Removal and/or Held
and/or Address
" Hold
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0 -
Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:j:: Permit Issued to Registration Number
::: Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
"''' Address
'r.:' 407 Bay Road,Queensbury, NY 12804
`;r Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
^ : Permission is her by ranted to dispose of the humar>�emains scribed a¢ove as in mate .
r:.*: Date Issued ® S//,. . f Registrar of Vital Statistics ,�i/ 0i
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition gully Place of Disposition gtal.. Coot .
2 (address)
W
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IX (section) A (lot numbe� (grave number)
ap Name of Sexton or Person in Charge of Premises t 1v1,t Jtnnt1F
Z (please print)
W Signature et` t— Title GUrk 1 t(ett
(over)
DOH-1555(02/2004)