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Chen.Chiaoyung NEW YORKSTATE DEPARTMENT OF HEALTH - Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Chiaoyung Chen Female Date of Death Age If Veteran of U.S.Armed Forces, 11/09/2019 82 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pMannerof Death ©Natural Cause Accident Homicide ❑Suicide Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title G Robert Love MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 485 Burial Date Cemetery,Crematory or Facility Name 11/13/2019 Pine View Crematory Entombment Address X❑Cremation Queensbury,New York ❑Donation 0 ❑Removal Date Place Removed and/or and/or Held F- Hold Address N O tL Date Point of M ❑Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address EjReinterment 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 Address W a Permission Is hereby granted to dispose of the human remains described above as Indicated. Date Issued 11/12/2019 Registrar of Vital Statistics �Xgbert Andrew Curtis(ECectronicaly Signed) (signature/ District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Place of Disposition V"j LU (address) W N (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of P mises �It'— L" /p ase print/ W Signature Title A DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013076 Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1