Loading...
Spring, Mary K. A Z1 c NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary K.Spring Female Date of Death Age If Veteran of U.S.Armed Forces, 02/24/2021 73 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Indian Lake Town Street Address 6448 State Route 30, Indian Lake Town, New York 12842 UJ p Manner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide Undetermined Pending W Circumstances Investigation WMedical Certifier Name Title CI Darci Gaiotti-Grubbs MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Indian Lake 2053 4 ❑Burial Date Cemetery,Crematory or Facility Name 02/25/2021 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York ❑Donation g ❑Removal Date Place Removed and/or and/or Held - Hold Address 0 C- Date Point of U) ❑Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/25/2021 Registrar of Vital Statistics Julie A Clawson(Electronically Signed) (signature) District Number 2053 Place Indian Lake, 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 21 zc Place of Disposition W (address) W N CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Char f Premises f+ t �^�`� /pleifk e prig IJJ Signature Title crirAir �� DOH-1555(07/18)p 1 of 2 4 i _� 4 Public Health Law Sec. 4145(2b) 1 `'� ''� Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#