Mastro, Sarah it z3
NEW YORK STATE DEPARTMENT OF HEALTH n it Permit
ermit
Vital Records Section ,, Burial Transit
Name First Middle Last Sex
Sarah Mastro Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 3,2012 96 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
,W Manner of Death I XI Natural Cause I I Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
n Medical Certifier Name Title
0 Daniel Way
Address
HHHN,North Creek,NY 12853
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 c7 CD,�j
❑Burial Date Cemetery or Crematory
May 4, 2012 Pine View Crematory
El Entombment
Address
®Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z
• I I Removal and/or Held
and/or Address
H Hold
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Q Date Point of
I I 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
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped, If Other than Above
X Address
IX
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,• Permission is her by anted to dispose of the human r mains de ribed ab e as indi ated�
Date Issued ( D` O/� Registrar of Vital Statistics (e.-2�ia-t� % 1 c \..
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were d posed of in accordance with this permit on:
w Date of Disposition 5(1((t Place of Disposition -P htU 4...) ( ni.riorI,L
(address)
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cn
O (section) (lot number) tL (grave number)
a Name of Sexton or P rson in Char a of Premises artt� ln4
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(please print)
Signature ilti k...,
Title CacrIA-Ntt
(over)
DOH-1555 (02/2004)