Trottii, Rosa Ella t sco7
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Rose Ella Trotti Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/09/2021 85 Years War or Dates
F— Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address 224 South St,Glens Falls,New York 12801
p Manner of Death ❑X Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined 0 Pending
W U Circumstances Investigation
W Medical Certifier Name Title
CI Patricia Stevenson PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 282
ElBurial Date Cemetery,Crematory or Facility Name
07/12/2021 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
OZ El Removal Date Place Removed
and/or Held
N and/or
Hold Address
N
0
Date Point of
Cl) 1-1
Transportation Shipment
p by Common
Carrier Destination
Disinterment 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
CC
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/11/2021 Registrar of Vital Statistics Wpbertf7ndrew Curtis(EYectrnnicalySOrte4
(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: ,
F—
?ALAI_
(
Z Date of Disposition ')1131 Z4 Place of Disposition _.
g (address)
W
CO (section) (lot number) (grave number)
O i4Name of Sexton or Person in Charge of Pr ses �f '��
Z (pleprint)
W — Title ` A"lik
Signature
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) Q 1 4 Q 4 6
Receipt
{
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#