Aiello, Dorothy Louise .* . ( 1 F ft 6 r'i
NEWYORKSTATEDEPARTMENTOFHEALTH _i \. Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Dorothy Louise Aiello Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/05/2022 71 Years War or Dates
f- Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
WW Manner of Death ❑ ❑Undetermined ❑Pendin
X Natural Cause Accident Homicide Suicide g
U Circumstances Investigation
W Medical Certifier Name Title
G Howard Silverberg MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 410
Burial Date Cemetery,Crematory or Facility Name
08/08/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
oz❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
U)
0
d Date Point of
U)ETransportation
p by Common Shipment
Carrier Destination
oDisinterment Date Cemetery Address
❑Reinterment
Date Cemetery Address
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
1— Remains are Shipped,If Other than Above
g Address
CC
Ills
4 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/08/2022 Registrar of Vital Statistics Megan Wolin(ECectronicallySigned)
(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 S/5(27._ Place of Disposition '[ r.,-c(L
4--
111.1
2 (address)
W
U) (section) 4 ,(lot umber)c (grave number)
GCCPPP//'l`
Name of Sexton or Person in Charge f Premises _ "t
Z Tease print)ILI r Ve
Signature Title
DOH-1555(07/18)p 1 of 2
1
1
1 Public Health Law Sec. 4145(2b)
1
Receipt
Human remains of " ` •
delivered on , 20
Pine View Cemetery Representing4he funeral home named on burial permit
Official Funeral Directors Reg.or License#