Serrao, Carol Mary (7--F) it --) 5
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Carol Mary Serrao Female
Date bf Death Age If Veteran of U.S.Armed Forces,
09/21/2022 79 Years War or Dates
1_, Place of Death Hospital,Institution or
Z City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing
is Manner of Death Undetermined Pending
W Natural Cause Accident Homicide Suicide g
Circumstances Investigation
W Medical Certifier Name Title
CI Shardul Koppar DO
Address
17 Madison St,Granville Village,New York 12832
Death Certificate Filed Village Of Granville District Number Register Number
City,Town or Village 5725 42
Burial Date Cemetery,Crematory or Facilit+ Name
09/23/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
H Hold Address
U)
0
Q. Date Point of
U) Transportation
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
N Address
CC
UJ
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/23/2022 Registrar of Vital Statistics DianaScar(otta(E(ectronicatTySigned)
(signature)
District Number 5725 Place Village Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F- �_.I'
Z Date of Disposition 9 I?l,I IL, Place of Disposition -t """��" (—
W
2 (address)
W
U)
Q (section) (lot number) (grave number)
gName of Sexton or Person in Char f Premises iii P i L-- w di
Z please print)
W Signature Title az6ffNpe
DOH-1555(07/18)p 1 of 2
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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#