Cocca, Margaret M Qui:—.t) II' 7.1 c
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Margaret M Cooca Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/17/2022 88 Years War or Dates
E,,. Place of Death Hospital,Institution or
WCity,town or Village Lake George Village Street Address 72 Cortland Street,Lake George Village,New York 12845
p Man nerof Death ID Natural Cause ❑Accident Homicide OSuicide ❑ ❑Undetermined Pending
III
0 Circumstances Investigation
W Medical Certifier Name Title
G Anthony Petracca MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Village Of Lake George District Number Register Number
Cit ,Town orVill a g 5620 6
Burial Date Cemetery,Crematory or Facility Name
09/20/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDon ation
3❑Removal Date Place Removed
p and/or and/or Held
N
Hold Address
0
CI. Date Point of
Cl)ElTransportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
EiReinterment
PernitIssued 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 Otherthan Above
3 Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/20/2022 Registrar of Vital Statistics Qaegraf Afc,Eiitney(Mctnmli S01:4
(signature)
District Number 5620 Place Village Of Lake George
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition q I2Z(27, Place of Disposition ,i2�c
4
2 (add,ess)
uJ
NCC /sectiunl / /i 1,- (tut nun (grave numbed
G Name of Sexton or Person in Charge 'emises
< �) (Please print)
M
al Signature Title ((f� i1T�
DOH 1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
1 Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#