Scarpellino, Maria Seveia 41.
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Maria Severia Scarpellino Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/20/2021 76 Years War or Dates
1.. Place of Death Hospital,Institution or
Z City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing
p Manner of Death II Natural Cause 1:1Accident El Homicide El Suicide LiUndetermined 0 Pending
VCircumstances Investigation
Medical Certifier Name Title
Leonard Gelman MD
Address
17 Madison St,Granville Village,New York 12832
Death Certificate Filed District Number Register Number
City,Town or Village Granville Village 5725 07
ElBurial Date Cemetery,Crematory or Facility Name
01/22/2021 Pine View Crematory
❑Entombment Address
Cremation Queensbury Town,New York
❑Donation
O Removal Date Place Removed
and/or and/or Held
i- Hold Address
CO
0
a. Date Point of
0) LI Transportation
Q by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
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
I— Remains are Shipped,If Other than Above
Address
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/21/2021 Registrar of Vital Statistics Vc1Tarrl&6erts(Electronical6,Vned)
(signature)
District Number 5725 Place Granville Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH
Z Date of Disposition //3-- 2/ Place of Disposition 62;,ue 0,; Cre.4#1 k Gt
g (address/'
lw
NCC (section) (tot number) (grave number)
GgoName of Sexton or Person in Cha e of Pre ise � �����
Z (please print)
W Signature /` Title Or�'� �
DOH-1555(o7/18)p i of 2
1
1
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Public Health Law Sec. 4145(2b) 014 4 5()
Receipt
a
Human remains of delivered on , 20
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7
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Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ___