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Larson, Linda Briggs NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Linda Briggs Larson Female Date of Death Age If Veteran of U.S.Armed Forces, 11/13/2019 72 Years War or Dates I—. Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital 'p Manner of Death © Natural Cause Accident 1:1Homicide Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Waric Itani MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2400 Burial Date Cemetery,Crematory or Facility Name 11/15/2019 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or —7and/or Held QN Hold Address a Date Point of U) Transportation Shipment 15 by Common Carrier Destination El Disinterment Date Cemetery Address Ej Reinterment 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 F— Remains are Shipped,If Other than Above M Address W W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/15/2019 Registrar of Vital Statistics (DanielTeS Gillespie(EfectronicalrySigned) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: �I Z Date of Disposition q Y I l� Place of Disposition F. ,✓ ` �' lu (address/ W 0 (section/ (lot number/ (grave number) G Name of Sexton or Person in Charge of Premises r•� �, �.af (/ease prin W Title N, % Signature DOH-1555(07/18)p 1 of 2 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# LF/ Town of Queensbury Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of. Linda Briggs Larson were cremated on November 15 20 19 at the Pine View (Month) (Day) Crematorium, Queensbury, New York, and these are the cremated remains of said body. Date of Death November 13 2019 Age 72 (Month) (Day) Funeral Home Regan, Denny, Stafford Funeral Home Registered No. 758 &' Z'- (Authorized Signature)