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Chaudry, Sumer 1 ,. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ' ' Name First Middle Last Sex Sumer Yousaf Chaudry Female 0,1 Date of Death 1 Age If Veteran of U.S.Armed Forces June 21, 2016 38 War or Dates n/a :' Place of Death Hospital, Institution or City, Town or Village Green Island Manner of Death Street Address Osgood Ave n Medical Certifier Natural Cause n Accident Homicide n Suicide n Undetermined Pending Circumstances Investigation Name Title , Paul Marra, Coroner !�f �-,;, Address Albany,NY Death Certificate Filed District Number Register Number 3 City, Town or Village O /'-/' .r..J ©Burial Date Cemetery or Crematory ID Entombment June 25, 2016 Pine View Cemetery Address 0 Cremation Quaker Road, Queensbury,NY 12804 Date _ Place Removed -- Z ❑Removal -- and/or Held and/or Address F" Hold N 0 Date Point of N ❑Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address ❑Renterment Date Cemetery Address %° Permit Issued to Registration Number 1< V> Name of Funeral Home Regan Denny Stafford Funeral Home 01443 '5. Address f 53 Quaker Road,Queensbury,NY 12804 P,1 Name of Funeral Firm Making Disposition or to Whom ' Remains are Shipped, If Other than Above Address %1 Permission is hereby granted to dispose of the human rem ' s describe above as indicated. ''f' Date Issued 441,-W 14 Registrar of Vital Statistics (signature) '.f District Number aq5� Place �. 'N G.f Lle --Z Lci Ts( icj 6Q I caso 0 u , 6,eE--=�.�s/�LJ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ui Date of Disposition 6/2 5/2 0 1 6 Place of Disposition Pine View Cemetery, Queen shin ry, 17v _ 2 (address) LU co Horicon 7H 1 (section) (lot number) (grave number) p Name of Sextpn or Person in Charge of Premises Connie L. Goedert Z �,' / (please print) Signature C... -e 6(, t.,k lau4r Title Cemetery Superintendent (over) DOH-1555(02/2004)