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Bradley, Mary Katherine
� If ?z1 NEW YORK STATE DEPARTMENT OF HEALTH (...f Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary Katherine Bradley Female Date of Death Age If Veteran of U.S.Armed Forces, 02/29/2024 57 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Lake George Town Street Address 323 Bloody Pond Road Unit B,Lake George Town,New York 12845 W Manner of Death Undetermined Pending 0 El Natural Cause Accident Homicide Suicide UCircumstances Investigation W Medical Certifier Name Title CI Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Lake George District Number Register Number City,Town or Village 5651 5 Burial Date Cemetery,Crematory or Facility Name 03/04/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 n. Date Point of U)ElTransportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address EIReinterment 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 F- 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 03/04/2024 Registrar of Vital Statistics Patricia cl 4cl(inney-Schuster(ECectronica1TYSigned) (signature) District Number 5651 Place Town Of Lake George I certify that the remains of the decedent identified above were disposed of in accordance with this permiton: W er Date of Disposition 31$12q Place of Disposition 4 511 4'r15u CO/ MATOtT.- 2 (address) W N Q (section) (lot nu{nber) (grave number/ savi S Name of Sexton or Person in Chargegf remises (hr'� I-- 4'f iti (phase print) Z W C _ir4 Signature Title DOH-1555(07/18)p 1 of 2 z Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#