Schadwill, Gladys Martha II Lir
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gladys Martha Schadwill Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/13/2021 99 Years War or Dates
�., Place of Death Hospital,Institution or
W City,Town or Village Canton Village Street Address Maplewood Health Care And Rehabilitation Center
• Manner of Death IJ Natural Cause ❑Accident 0 Homicide Suicide Undetermined Pending
`
fv3 Circumstances Investigation
W Medical Certifier Name Title
O Jordan Woodside NP
Address
205 State Street Rd,Canton Village,New York 13617
Death Certificate Filed District Number Register Number
City,Town or Village Canton Village 4420 6
❑Burial Date Cemetery,Crematory or Facility Name
01/14/2021 Pine View Crematory
Entombment Address`
gCremation Queensbury. Town,New York
0 Donation
O• ElRemoval Date Place Removed
and/or and/or Held
- Hold Address
1-1
O
n. Date Point of
U) ❑Transportation Shipment
p by Common
Carrier Destination
Disinterment Date Cemetery Address
El
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
s Address
C
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/14/2021 Registrar of Vital Statistics Sa/5 LNn6ke(Ekctromthlr Signed)
(signature)
District Number 4420 Place Canton Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ZW Date of Disposition Place of Disposition ei?o c 11'40—"
2 (address)
W
CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Pre ` ieaseprinm4^
t)
W Title C 0ww-7°�.
Signature
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b) 01 4411
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#