Hill, Mae L il 7 s-L
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mae L.Hill Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/21/2022 90 Years War or Dates
H Place of Death Hospital,Institution or
City,l own or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause DAccident El Homicide ❑Suicide Undetermined 1—Vending
W
C.) Circumstances Investigation
W Medical Certifier Name Title
a Howard Silverberg MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Village
g 5601 487
Burial Date Cemetery,Crematory or Facility Name
09/23/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Don alio n
0❑Removal Date Place Removed
and/or and/or Held
CD Hold Address
0
Ct. Date Point of
N❑Tran spo rlatio n Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
pReinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped,If Otherthan Above
5 Address
CC
W
0. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/22/2022 Registrar of Vital Statistics Alvan SlWolrn(*EYsctmnrca(Srgnrd
(3ignatmel
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;
WDate of Disposition 9-14AZDZZe.lace of Disposition Y ` 0Q v,i e.,) Cr. ie t 4 1-61
2 (addle»)
W
NCC (section/ (lot numbed i (pave numbed
el
0 Name of Sexton or Person in Charge f Premises /)Y 1 oil b�
y ; (p`�
leasc pilot)
W Signature lff/j�� Title it����t/
DOH 1555(07/18)pi of 2 yy
r a 'r
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#