Stubing, Mary S- 962
NEW YORK STATE DEPARTMENT OF HEALTII
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary M. Stubing Female
-; Date of Death Age If Veteran of U.S. Armed Forces,
October 8,2013 83 War or Dates
' Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center, Inc
Manner of Death I XI Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
1u Medical Certifier Name Title
44 Rick D. Teetz Dr.
Address
131 Lawrence St.,Saratoga Springs,NY 12866
Death Certificate Filed District Number Register Number
M_,«: City, Town or Village Saratoga 4501 Licce
❑Burial Date Cemetery or Crematory
El Entombment October 10,2013 Pine View Crematory
Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
cn
aDate Point of
0 Transportation Shipment
p 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
E`: 3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Gl * Remains are Shipped, If Other than Above
Address
, Permission is hereb granted to dispose of the human rem ' scr ed a4bor indica d.
: Date Issued Registrar of Vital Statistics U.
(signature)
g: District Number 4501 Place Saratoga
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
AuiZ Avd,
Date of Disposition /01 o -/3 Place of Disposition �,.,," ,944/
w (address)
CO
Z0 (section) /� t number) (grave number)
Name of Sexton Pe on i., 4 rge of Premises S�p 1 �LV l�'�'1d
(please print)
w Signature 1� Title ie 1.
(over)
DOH-1555 (02/2004)