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Catalfamo, Mary Lou 4(795 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary Lou Catalfamo Female Date of Death Age If Veteran of U.S.Armed Forces, 09/15/2021 71 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 9 Glen Court,Queensbury Town,New York 12804 p Manner of Death ©Natural Cause El Accident ❑Homicide ❑Suicide 0 Undetermined n Pending W Circumstances Investigation W Medical Certifier Name Title G Donald Memhew MD Address 319 Bay Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 193 ❑Burial Date Cemetery,Crematory or Facility Name 09/17/2021 Pine View Crematorium ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation ZO ❑Removal Date Place Removed and/or and/or Held H Hold Address 0 a Date Point of U) 1-1 Transportation Shipment p by Common Carrier Destination Date Cemetery Address ❑Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above 2 Address uJ 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/17/2021 Registrar of Vital Statistics Caroline x&legarde Barber(Electronica(ly 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: W Date of Disposition 9—/ 'eDZ I Place of Disposition t,. e V, etelit (address) W Ct (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of remises ! !"��� "- (t�� Z (please print) uJ Signature Title 1,r.1 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of e :'c: delivered on , 20 } Pine View Cemetery Representing the funeral home named/oil l39rial permit Official Funeral Directors Reg.or License# +