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Cooper, JoanNEW YORKSTATE DEPARTMENT OF HEALTH B • I Bureau of Vital Records urea - Transit Permit Name First Middle Last Sex Joan Cooper Female Date of Death Age If Veteran of U.S. Armed Forces, 09/30/2019 88 Years War or Dates II.— Place of Death Hospital, Institution or Z City, Town or Village Queensbury Town Street Address 17 Ryan Avenue, Queensbury Town, New York 12804 pI Mannerof Death © Natural Cause Accident Homicide Suicide Undetermined Pending V Circumstances Investigation WD Medical Certifier Name Title Michael Bell MD Address 9 Carey Road, Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City, Town or Villa a Queensbury 5657 144 © Burial Date Cemetery, Crematory or Facility Name Entombment 10/04/2019 Pine View Cemetery Address Cremation Queensbury Town, New York Donation Date Place Removed 0 Removal and/or and/or Held ~ N Hold Address O IL N Transportation Date Point of jS by Common Shipment Carrier Destination Disinterment Date Cemetery Address lFiReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd, Queensbury, New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address X W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/03/2019 Registrar of Vital Statistics Carofine Mi(fegarde Bar6er(ECectronicaCCy Signer) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i— W Date of Disposition 10 4 2 01 9 Place of Disposition address/ 2 W Horicon 28-C N (section) (lot number) (grave number) cc O Name of Sexton or Person in Charge of Premises Connie L . Goedert (please print/ W Signature Title Cemetery Superintendent DOH-1555 (07/18) p 1 of 2 Public Health Law Sec. 4145(2b) 010345 Receipt Human remains of �' rF' , delivered on _ / , 20 1 0 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License #