Ferraro, Mary Sue it s1z
NEW YORKSTATE DEPARTMENT OF HEALTH A + Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mary Sue Ferraro Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/18/2021 83 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 24 McCormick Drive,Queensbury Town, New York 12845
1111
0 Manner of Death Q Natural Cause 1=I Accident ElHomicide p Suicide Undetermined 0 Pending
WI
0 Circumstances Investigation
LU Medical Certifier Name Title
CI Laurie Dennison NP
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 129
Burial Date Cemetery,Crematory or Facility Name
06/22/2021 Pine View Crematory
El Entombment Address
E1Cremation Queensbury Town,New York
❑Donation
ZRemoval Date Place Removed
and/or and/or Held
f- Hold Address
N
0
d Date Point of
CA Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
}_— Remains are Shipped,If Other than Above
"i Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/22/2021 Registrar of Vital Statistics Caroliinexkfegarde Barher(Electron ca/T Signed
(signature)
District Number 5657 Place Queensbury, 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 Wit Wilti4 Place of Disposition v 4 d 6--....,
LU
2 (address)
W
NIZ (section) lot number) { (grave number)
.5N
0 /r'., 1, „""it
0 Name of Sexton or Person in Charge of Prem. es
Z /pleas print/ ;
Ui Signature Title alc.Atrjik
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014650
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#