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Otto, Maureen Town of Queensbury Certification of Cremation i Pine View Cemetery and Crematory This certifies that the remains of: Maureen Otto were cremated on October , 18 20 23 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death October 12 20 23 Age 61 (Month) (Day) Funeral Home Singleton Sullivan Potter Registered No. 835 (Authorized Signature) ( _F' / NEW YORK CITY THE CITY OF NEW YORK-DEPARTMENT OF HEALTH AND MENTAL HYGIENE '\ DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS AND MENTAL HYGIENE October 16,2023 02:45 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS 156-23-042630 EVENT:(CHECK ONLY ONE) 1 DEATH 0 SPONTANEOUS TERMINATION 0 INDUCED TERMINATION --CERTIFICATE NUMBER NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR OF Maureen Otto 61 Female EVENT 10 12 2023 BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS PLACE OF NEW YORK CITY EVENT Manhattan 1468 Madison Ave, Manhattan, NY 10029 NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY: CERTIFIER METHOD ❑ INTERMENT X CREMATION OF ME/MLI James Meyer Alexander Bognot DISPOSAL ❑ OTHER M.E.CASE r M23029808 PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CITY OR COUNTY AND STATE DATE MONTH DAY YEAR DISPOSITION OF Pine View Crematory Queensbury, NY DISPOSITION 10 17 2023 THE CERTIFICATE OF DEATH HAVING BEEN FILED AS REQUIRED BY THE HEALTH CODE,AND ALL LAWS AND REGULATIONS GOVERNING THE PREPARATION AND DISPOSAL OF HUMAN REMAINS HAVING BEEN COMPLIED WITH, PERMISSION IS HEREBY REQUESTED TO DISPOSE OF THE REMAINS AS IDENTIFIED ABOVE. NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.# FUNERAL ESTABLISHMENT Riverdale Funeral Home 5044 Broadway New York NY 01475 NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LIC.# APPLICANT Nicholas Apostle W qpogeSkfran arimPy Adihenbattsd 10097 PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE , it• 'VI: •UESTED ABOVE. NOTICE: This permit is not valid without the seal of the Department �•i. ,4!•f lit;i1/1e......e0 of Health and Mental Hygiene;or if it has been corrected, =•a' _ �� interlined or altered in any manner. Zsl; `-.'if C Registrar %* �..�,. •- Y 9 VR 21(REV.7/09) FEE PAID$40.00 DATE 10 / 16 /2023 4•. " *• . By Service Evital MM DD YYYY tkt t - 41r NEW YORK CITY THE CITY OF NEW YORK-DEPARTMENT OF HEALTH AND MENTAL HYGIEN DEPARTMENT OF HEALTH OFFICE'OF VITAL RECORDS AND MENTAL HYGIENE October 16,2023 02:45 PM PERMIT TO DISPOSE OF OR TRANSPORT HUMAN REMAINS 156-23-042630 EVENT:(CHECK ONLY ONE) NI DEATH ❑SPONTANEOUS TERMINATION 0 INDUCED TERMINATION -� CERTIFICATE NUMBER� NAME First,Middle,Last AGE SEX DATE MONTH DAY YEAR Y) OF Maureen Otto 61 Female EVENT 10 12 2023 BOROUGH NAME OF HOSPITAL OR INSTITUTION OR STREET ADDRESS PLACE OF NEW YORK CITY EVENT Manhattan 1468 Madison Ave, Manhattan, NY 10029 NAME OF PHYSICIAN OR MEDICAL EXAMINER'S NUMBER CREMATION APPROVED BY: CERTIFIER METHOD ❑ INTERMENT X CREMATION OF ME/MLI James Meyer Alexander Bognot DISPOSAL ❑ OTHER M.E.CASE#M23029808 PLACE OF NAME OF CEMETERY OR CREMATORY(OR DESTINATION) CfTY OR COUNTY AND STATE DATE MONTH DAY YEAR OF (YYYY) DISPOSITION Pine View Crematory Queensbury, NY DISPOSITION 10 17 2023 THE CERTIFICATE OF DEATH HAVING BEEN FILED AS REQUIRED BY THE HEALTH CODE,AND ALL LAWS AND REGULATIONS GOVERNING THE PREPARATION AND DISPOSAL OF HUMAN REMAINS HAVING BEEN COMPLIED WITH, PERMISSION IS HEREBY REQUESTED TO DISPOSE OF THE REMAINS AS IDENTIFIED ABOVE. NAME OF ESTABLISHMENT ADDRESS CITY AND STATE N.Y.STATE REG.# FUNERAL ESTABLISHMENT Riverdale Funeral Home 5044 Broadway New York NY 01475 APPLICANT NAME OF N.Y.STATE LICENSED FUNERAL DIRECTOR(PRINT) SIGNATURE N.Y.STATE LC.# aririCa /�� Nicholas Apostle �� ' Signature ElectIonkaly AutlIentidted 10097 PERMISSION IS HEREBY GRANTED TO DISPOSE OF THE RE , 4k. 'ti'f); 0UESTED ABOVE. NOTICE: This permit is not valid without the seal of the Department elt _•• !a✓ of Health and Mental Hygiene;or if it has been corrected, • A•< ��'��aGy Q/1�� interlined or altered in any manner. `% 5.• ', CO Registrar VR 21(REV.7/09) FEE PAID$40.00 DATE 10 / 16 /2023 V.-'„• •:-#* By Service Evital MM DD YYYY ••• ` �"OF NEVIV Public Health Law Sec. 4145(2b) Receipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ' 7 > ' OTTO Lot No. 5-A ddress 31 Country Colony Rd . Queensbury , NY 12804 Section No. mwner Richard & Maureen Otto Plot Horicon ate 8/27/01 Approx . 67 Superficial ft. ocation Bounded on North by Vacant , South by Webb , East by Road , West by Vacant . orner Posts emarks eed No. (and changes) 3131 ayment Record Paid in Full 8/27/01 ($800 . 00) ecord of Interments V / ) uo� o— i© ac. � �r� 3 W LA) A 5-1:11/4:j � c rt lV i T ►rm No. 01 OTTOLF ; f NAME Maureen Otto ; Age: 61 Lot Owner: Richard & Maureen Otto Lot# Horicon 5A Grave# 2 Case: Urn Died: 1 0. 1 2.23 Interred: 1 0.2 0.2 3 Funeral Home: Singleton Sullivan Potter Cemetery: Pine View