Crocitto, Mary Beth NEW YORK STATE DEPARTMENT OF HEALTH �� ' ��
Bureau of Vital Records
k Burial - Transit Permit
Name First Middle Last Sex
Mary Beth Crodtto Female
Date of Death Age If Veteran of U.S.Armed Forces,
O6/04/2022 70 Years War or Dates
IH Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death 1:1 Natural Cause ❑AccidentHomicide ❑Suicide ❑Undetermined ❑Pending
W
C.) Circumstances Investigation
CMedical Certifier Name Title
Christopher Smith MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
C' ,Town o r Vi llle 5601 303
Burial Date - Cemetery,Crematory or Facility Name
06/07/2022 ' Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
ElDonation
g 0Removal Date Place Removed
and/or and/or Held
pN Hold Address
0
O Date Point of
(A❑Transportation
a by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
H Remains are Shipped,If Other than Above
S Address
IIC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/06/2022 Registrar of Vital Statistics ,4fVan Aran(Ffictmttica4y,figne4
(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>—
WDate of Disposition to 181'It Place of Disposition ,I
2 (address)
W
CO (sedion) (Iptnumber) ("--, (grave number)
8 Name of Sexton or Person in Charge of remises t 01 ` = ^. � wit
z
/phase print)
W Signature �L� Title ` /�ql
DOH 1555(o7/18)p t of 2
FLLi A.,,7 7 `,
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#