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Hundertmark, Mary L 1.2F) i:1-- cg 67 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records a Name First Middle Last Sex Mary L Hundertmark Female Date of Death Age If Veteran of US.Armed Forces, 10/28/2023 73 Years War or Dates 1,., Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death �Natural Cause Accident EliHomicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G Gwendolyn Morris-Dickinson PA Address 100 Park St,Glens Falls,New York 12801 a Death Certificate Filed City Of Glens Falls District Number Register Number n' City,Town or Village 5601 499 a — ''= Burial Date Cemetery,Crematory or Facility Name 10/31/2023 Pineview Crematory Entombment _ Address • ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held Hold Address 0 ar Date Point of (❑Tran sportation aby Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom H 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 10/30/2023 Registrar of Vital Statistics Megan Nolin(Electronically 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: ZZ --, Date of Disposition 10 I31113 Place of Disposition (?,,s4- (p 'v T7QT.v•—, ,2 (address) W OC (section) 1 (lot number) (grave number) 8Name of Sexton or Person in Charge of P ises 7r n*� Ai Z / se prior) W ,......-Signature Title 1' !' DOH-1555(07/18)p 1 of 2 a r Public Health Law Sec. 4145(2b) Receipt i Human remains of v` delivered one ' ` r , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#