Mester, Carol Mardel Io1
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First ' Middle Last Sex
Carol Mardel Mester Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/28/2021 81 Years 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 Undetermined Pending
W EI Natural Cause Accident Homicide Ei Suicide
Circumstances Investigation
Medical Certifier Name Title
Kelly Maley PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 62
ElBurial Date Cemetery,Crematory or Facility Name
01/29/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
ElDonation
0 Removal Date Place Removed
and/or and/or Held
Hf� Hold Address
0
O. Date Point of
to Transportation
Transportation
p by Common Shipment
Carrier Destination
LiDisinterment 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
2 Address
OC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/29/2021 Registrar of Vital Statistics q'.n6ert,?n1rewCurtzrgketranica45'Siwne9
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 1- --dpz( Place of Disposition 4 �e J,&/ Cie i>J
2 (address)--'
W
N Q (section) (lot numb r) (grave number)
0 Name of Sexton or Person in Ch ge of Pre s a�/Y1l�Nd vLid
Z (please print)
W Signature Title Qfp�tom
DOH-1555(07/18)p 1 of 2
- ,e. gip;
Public Health Law Sec. 4145(2b) 1 _.r 4
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#