Mabb, Gary Lee NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gary Lee Mabb Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/23/2021 80 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 43 Ridge Street APT 611,Glens Falls, New York 12801
WW Manner of Death El
Natural Cause ID Accident El Homicide Suicide El Undetermined Pending
V Circumstances Investigation
Wi0 Medical Certifier Name Title
Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 363
ElBurial Date Cemetery,Crematory or Facility Name
08/26/2021 Pine View Crematory
❑Entombment Address
gCremation Queensbury Town,New York
ElDonation
Date Place Removed
g Removal
and/or and/or Held
H Hold Address
N
0
CL Date Point of
U) Li Transportation
by Common Shipment
Carrier Destination
ElDisinterment 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
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 08/26/2021 Registrar of Vital Statistics &Cen./IndrewCurtis(Electronic4ISigned)
(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
Z Date of Disposition 8-�7-.1.1 Place of Disposition p�y-, tA",L,, (,rcik(dory
LIJ
(address)
W
CC CC (section) (lot number) (grave number)
GName of Sexton or Person in Charge of Premises S00,;,T�S
Z 4 (please print)
W Signature Title Cir‹,yrkc'ft/r
DOH-1555(07/18tp I of 2
Public Health Law Sec. 4145(2b) 0
Receipt
Human remains of 4 k ' + ! delivered on , 20
'"Pine View Cemetery Representing the funeral home named on burialpermit
Official Funeral Directors Reg. or License#