Hunter, Mary Lou dil
NEW YORK STATE DEPARTMENT OF HEALTH v - _k 4- tsce
Bureau of Vital Records Burial - Transit Permit
IName First Middle Last
Mary Lou Hunter Sex
Female
Date of Death
I Age If Veteran of U.S.Armed Forces,
07/12/2022 78 Years War or Dates
f. Place of Death Hospital,Institution or
ILI
Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
O Manner of Death a Natural Cause Accident 0 Homicide Suicide FlUndetermined ri Pending
W
GU Circumstances Investigation
Medical Certifier Name Title
Elizabeth Bessette NP
Address
152 Sherman Ave,Queensbury jpwn,Iry York 12801
Death Certificate Filed
Town Of Queenstiry District Number Register Number
City,Town or Village s'' 5657 107
Burial Date - Cemetery,Crematory or Facility Name
® 07/15/2022 h Pine View Crematory
Entombment
— Address
jCremation Queensbury Town,New York
Donation
0ORemoval Date Place Removed
and/or and/or Held
— Hold Address
CO
a Date Point of
(I)❑Transportation
0 by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
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
H Remains are Shipped,If Other than Above
a Address
C
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/13/2022 Registrar of Vital Statistics Caroline x(degarde gather(E(ectronicallySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition '7 I►!)1Z Place of Disposition •FiNt.V,,,..- eto,r,
IILI
(address)
W
in
(section/ lot/ number) (grave number)
d0 f/i t �pL if
Name of Sexton or Person in Charge of Prises t" }
(pleas print)Z /+
!Li Title Title (�
DOH-1555(0W18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
1 Human remains of ` delivered on , 20
1
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#