Hunter, Mary Louise NEW YORK STATE DEPARTMENT OF HEALTH LOF Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mary Louise Hunter Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/08/2022 79 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 12 Chester Street,Glens Fails,New York 12801
W Manner of Death Undetermined Pending
W Natural Cause Accident Homicide Suicide
Circumstances Investigation
WMedical Certifier Name Title
Danielle Moriarity NP
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 209
X Burial Date Cemetery,Crematory or Facility Name
04/14/2022 Pine View Cemetery
Entombment Address
Cremation Queensbury,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
- Hold Address
0
C- Date Point of
U)IIITransportation
p by Common Shipment
Carrier Destination
O
Disinterment
Date Cemetery Address
Date Cemetery Address
E Reinterment
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
1— Remains are Shipped,If Other than Above
a Address
Q
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/12/2022 Registrar of Vital Statistics 3leganWolin(ECectronicaCTySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition - •aa, Place of Disposition al Qua\ R R.O �1 �c /Y`/ /?o�
W /
2 (address)
W /-/qIG a7.L 1
(/)CC (section) (lot number) (grave number)
aName of Sexton or Person in Charge of Premises ®nnte �Qec1C212.
Z // (please print/I)
IIJ Signature yg. Title ,�llf!I1—CJlUte!)L
DOH-1555(o7/18)p i of 2
Public Health Law Sec. 4145(2b)
012906
Receipt
Human remains of , , , . delivered on — I' 1 , 20 ,
\„/‘,., , 4 .,--...::^L:3-••• -
, 1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
HUNTER
NAME Mary1(1.03 Age:Louise Hunte 79
Lot Owner: Mary Hunter
Lot# Erie 2D Grave# 1
Case: Concrete
Died: 4 .8.2 2 Interred: 4 . 14 .22
FuneralHome:Regan Denny Stafford
Cemetery: Pine View