Monizio, Mia Marie L .
NEW YORK STATE DEPARTMENT OF HEALTH
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mia Marie Morizio Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/28/2022 20 Days War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
pManner of Death LINaturalCause Accident El Homicide Suicide Undetermined n Pending
W U Circumstances Investigation
G Medical Certifier Name Title
Meredith Monaco-brown MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 2253
Burial Date Cemetery,Crematory or Facility Name
09/30/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
DDonation
4SEIRemoval Date Place Removed
and/or and/or Held
NHold Address
0
O. Date Point of
Cl)❑Transportation Shipment
S by Common
Carrier Destination
ElDisinterment Date Cemetery Address
El
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
-. Remains are Shipped,If Other than Above
2 Address
CC
W
CI. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/29/2022 Registrar of Vital Statistics DDaniel1i S gi Tsspie(`ECectronicaAy Signed)
(signature/
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
--�
Date of Disposition 101;3j 1 Z Place of Disposition -F�.t L 4- -____
W (address)
W
CC (section) //otnumber/ (grave number)
8 Name of Sexton or Person in Charge of ses
//1 o i L
z (ple a print)
W Signature Title c (n�M`�ni
DOH-1555(07/18)p 1 of 2
i
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#