Loading...
Mainwaring, Gladys Fraser NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gladys Fraser Mainwaring Female Date of Death Age If Veteran of U.S.Armed Forces, 11/30/2020 84 Years War or Dates E_ Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 20 Beekman Place,Queensbury Town,New York 12804 O Manner of Death ©Natural Cause Accident Homicide Suicide El Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title O Eric Borden MD Address 3044 Route 50,Wilton Town,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 215 ❑Burial Date Cemetery,Crematory or Facility Name 12/02/2020 Pine View Crematory ❑Entombment Address EJCremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held f-N Hold Address 0 a 1-1 Date Point of U) ❑Transportation Q by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom -. Remains are Shipped,If Other than Above a Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/02/2020 Registrar of Vital Statistics Caroline 7fi(degarfeBarber(E(ectronicalTySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: z �W Date of Disposition 1714 170 Place of Disposition 2 (address) W CC CC (section) A/ot number) (grave number) 8 Name of Sexton or Person in Charge of Premise + r-J Z 444-1 (pleas rint) W Signature Title tair^4412/1- DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) .' . 12 F 1 Receipt Human remains of rt delivered on i , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#