Demeo, Mariagnes Veronica NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mariagnes Veronica DeMeo Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/26/2021 71 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death ❑X Natural Cause ❑Accident ❑Homicide El Suicide Li
Undetermined Pending
IL Circumstances Investigation
W Medical Certifier Name Title
Marcille Labban MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 419
Burial Date Cemetery,Crematory or Facility Name
09/28/2021 Pine View Crematory
❑Entombment Address
I.:Cremation Queensbury Town,New York
ElDonation
Removal Date Place Removed
and/or and/or Held
- Hold Address
to
0
d 1-1 Date Point of
f/) ❑Transportation
by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
Date Cemetery Address
Reinterment
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
F. Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/27/2021 Registrar of Vital Statistics p6ert Andrew Curds(Electronica(Siwne42
(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:
WDate of Disposition ¶13c I Z+ Place of Disposition `l r toA C••1�d u...-
2 (address)
W
CC N
(section) /� (lot number) (grave number)
c, Name of Sexton or Person in Charge of Premises `//i1/�`} L' �n"i 4�f
lease print)
lL Signature Title �Y PM�ft
DOH-1555(o7/18)p t of 2
01. 5
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# ,