Brocchi-Legault, Mary Jane • g6e0
NEW YORKSTATE DEPARTMENT OF HEALTH � Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mary Jane Bocchi-Legault Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/30/2022 71 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death ❑X Natural Cause Accident ❑Homicide DSuicide Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 550
Burial Date Cemetery,Crematory or Facility Name
11/01/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
6❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
a Date Point of
. Transportation
ES Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
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
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/01/2022 Registrar of Vital Statistics Megan No(in(ECectronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition ///2 1 1 L Place of Disposition
2 (address)
W
CC N
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of P ises ri L--
lease print)
W Signature Title r r
DOH-1555(018)p t of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on b iti4l permit
Official Funeral Directors Reg.or License#