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Mazzone, Pauline H
// Ss3 r NEW YORKSTATE DEPARTMENT OF HEALTH / N Burial - Transit Permit Bureau of Vital Records Name First Middle` Last Sex Pauline H Mazzone Female Date of Death Age If Veteran of US.Armed Forces, 07/04/2021 85 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Undetermined Pending W Manner of Death © Natural Cause �Accident 0 Homicide �Suicide El Circumstances Investigation W Medical Certifier Name Title O Andrew Gamer MD Address 8 Harrison Harrison Avenue,Glens Falls,New York 12801 Death Certificate Filed District Numbe1.11144141‘ Register Number City,Town or Village Glens Falls 5601 275 ❑Burial Date Cemetery,Crematory or acility Name 07/07/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation ..•... Z ❑Removal Date Place Removed and/or and/or Held H f� Hold Address 0 O. 1-1 Date Point of to ❑Transportation Shipment p by Common Carrier Destination • Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address - 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above 2 Address It W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/07/2021 Registrar of Vital Statistics 96ertAndrew Curtis(ECectronically 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: I— W Date of Disposition -]��' Z� Place of Disposition ►��1 4. D—� 2 (address) W NCC (section) j (tgt number) (grave number) 0 Name of Sexton or Person in Charge of Premiss tit Z (pi a print W Signature Title A V DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014920 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# Town of Queensbury Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Pauline Mazzone were cremated on July , 8 20 21 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death July , 4 20 21 Age 85 (Month) (Day) Funeral Home Regan Denny Stafford Registered No. 553 (Authorized Signature) MAZZONE NAME Pauline Mazzone Age: 85 Lot Owner: Pauline Bauer Lot# Hudson 17A Sec. #1 Grave# 2A Case: Urn Died: 7.4.2 0 21 Interred:7 . 9.2 0 21 Funeral Home: Regan Denny Stafford Cemetery: Pine View