Baldwin, Mary I fi5
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section ..
:r Name First Middle Last Sex
Mary R Baldwin - Female
f Date of Death Age If Veteran of U.S. Armed Forces,
r;:, August 14, 2014 74 War or Dates
'i Hospital, Institution or
Place of Death P�
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death !XI Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier
i:
Name Title
1. Robert Sponzo,MD
:.:N. Address
iig Park Street,Glens Falls,NY 12801
Death Certificate Filed District Numbe5601 Register Number
;r; City, Town or Village Glens Falls 5 60( 3 -
El Burial Date Cemetery or Crematory
August 15, 2014 Pine View Crematory
❑Entombment Address
El Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
F_ Hold
r)
0 Date Point of
O.
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
ed
F7. Permit Issued to Registration Number
k;: Name of Funeral Home Regan Denny Stafford Funeral Home 01443
xe
Address
`S`r 53 Quaker Road,Queensbury,NY 12804
:47r ; Name of Funeral Firm Making Disposition or to Whom
I`'" Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
;;:;; Date Issued /I+-I fill Registrar of Vital Statistics LA)ciwine-1 k.A1A.A.4-
'•;: (sig tune)
-% District Number 5601 Place Glens Falls �I 0
r
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition q-is-0.4 Place of Disposition AtUtl..,1 C ter,_,..
2 (address)
W
U)
OG (section) (lot nur) (grave number)
00 Name of Sexton or Person in Charge of remises J_. r+wt
Zease print)
W Signature 4-- Y Title OM 4t:1The
(over)
DOH-1555(02/2004)