Rossler,Maria , ( Li- i; 4- g y.g
NEW YORK STATE DEPARTMENT OF HEALTH ` � ` Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Maria Roessler Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/14/2022 89 Years War or Dates
f.. Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address 390 Church Street, Saratoga Springs, New York 12866
W Manner of Death
❑X
W Natural Cause nAccident ❑Homicide OSuicide Undetermined Pending
✓ Circumstances Investigation
0ILI Medical Certifier Name Title
Madison Zuis NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 673
Burial Date Cemetery,Crematory or Facility Name
11/16/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
M
0
O. Date Point of
Cl)❑Transportation
p by Common Shipment
Carrier Destination
Disinterment 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
i- Remains are Shipped,If Other than Above
2 Address
IZ
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/16/2022 Registrar of Vital Statistics Dillon Moran((Yctranicai3iSigned)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition II/it,/Z Z Place of Disposition C
ILI
2 (address)
W
CO
(section) of number) (grave number)
SName of Sexton or Person in Charge of ' s o �lt
Z (please int)
W Signature Title tI�
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of k.-A delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#