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Lenko Mary A
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary A Lenko Female Date of Death Age If Veteran of U.S.Armed Forces, 09/19/2021 57 Years War or Dates - Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital 'p Manner of Death © Natural Cause 0 Accident Homicide 0 Suicide El Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title CI Chirag Patel Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number — Register Number City,Town or Village Albany 0101 2345 ❑Burial Date Cemetery,Crematory or Facility Name 09/22/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York 0 Donation Removal Date Place Removed and/or and/or Held N Hold Address U) ❑Transportation Date Point of S by Common Shipment 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 E.. Remains are Shipped,If Other than Above 2 Address Q W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/22/2021 Registrar of Vital Statistics -Danielle S GiC(espie(ElectronicalTy Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ZlI2�� DispositiontP �I l,4d.-- W Date of Disposition if Place of �r► �� (address) W CC N (sealant 11 (lot number,- (grave number) QName of Sexton or Person in Charge of remises /•1}p Z / (pease print) W Signature Title 4.71`1 DOH-1555(07/18)pi of 2 t Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#