Sokol, Mary Kathy . LF .it- 7(0
NEW YORK STATE DEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mary Kathy Sokol Female
Date of Death Age If Veteran of U.S.Armed Forces,
09R8/2022 70 Years War or Dates
Place of Death Hospital Institution or
Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
'g' Manner of Death El Natural Cause Accident 0 Homicide OSuicide Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Leah Terry NP
Address �_
4573 4573 NY-40,Argyle Town,New York 12809
Death Certificate Filed Town of Argyle District Number Register Number
,Town or Villa5e C' e 5750 54
Burial Date Cemetery,Crematory or Facility Name
O9/30/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
8 Removal Date Place Removed
F and/or and/or Held
CO Hold Address
0
t. Date ' ' Point of
4A Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
p Re interment
Date Cemetery Address
Pe Re
Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Hone 01130
Address
11 Lafayette St,Queensbury,New York 12804
4,, Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped,If Other than Above
a Address
Q
tii
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/30(2022 Registrar of Vital Statistics Snit'j,Alckfrnon(EIectmnsiaQysrgnsd)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 1013)TZ Place of Disposition -I 1u Vi._ Zif eV— -Z—
2 (address/
W
NCC (section) /(W number) (grew number/
8 Name of Sexton or Person in harge of Premise 4
Z (pi se print/
11J Signature ,, Title 6,4 m
47-rte
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named qn burial permit
Official Funeral Director e - •