Loading...
Thomas, Mary NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Mary F. Thomas Female Date of Death Age If Veteran of U.S. Armed Forces, October 22,2013 75 War or Dates .. Place of Death Hospital, Institution or Z City, Town or Village Queensbury Street Address 179 Assembly Point Road Wp Manner of Death ❑X Natural Cause l i Accident ❑Homicide E Suicide ❑Undetermined Pending W' Circumstances Investigation W Medical Certifier Name Title .mod,,. ?�i��- . ,1119 Address ,Saratoga Springs,NY 12850 Death Certificate Filed District Number Register Number City, Town or Village Queensbury 5657 /``S--- ❑Burial Date Cemetery or Crematory ❑Entombment October 25, 2013 Pine View Crematorium Address ©Cremation 21 Quaker Road,Queensbury,NY 12804 Date Place Removed ZO n Removal and/or Held and/or Address H Hold N 0 Date Point of N ❑Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Road, Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above IAddress W D. Permission is hereby granted to dispose of the human rem s described above a ' dicated. Date Issued `r -3w/? Registrar of Vital Statistics 1J_, A_ _ (signature) District Number 5657 Place Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition tog L%h3 Place of Disposition ?Zit./ Conek ir. -- 2 (address) W U) re (section) (lot dumber)( (grave number) pName of Sexton or Pers in Charge f Premises IL; , S,`rd. Z (please print) W ITISignature Title CiMml}Tr'12- (over) DOH-1555(02/2004)