Petrazzuolo, Sabrina Marie NEW YORK STATE DEPARTMENT OF HEALTH "`Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Sabrina Marie Petrazzuolo Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/03/2021 50 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
ILI
0 Manner of Death II Natural Cause 0 Accident 0 Homicide El Suicide 0 Undetermined 0 Pending
tU
0 Circumstances Investigation
W Medical Certifier Name Title
0 William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 201
Burial Date Cemetery,Crematory or Facility Name
05/10/2021 Pine View Crematory
ElEntombment Address
aCremation Queensbury Town,New York
❑Donation
ZO ri Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
co LI Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
❑ Reinterment
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
p.. 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 05/06/2021 Registrar of Vital Statistics 1636ert_ 711frwCurtis(Ekectronical6,Signed)
(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:
H
W5-Date of Disposition 1101 11 Place of DispositionZ1-0---.
2 `l (address)
Ili
NCC (section) (lot number) (grave number)
Name of Sexton or Person in Charge f Premises Litpt.., A'l�
Z (!ase print)
W Signature (�' Title IMH
g
DOH-1555(o7/18)p i of 2
Public Health Law Sec. 4145(2b) 4 .7 7
Receipt {`
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#