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Beavers, Louann M. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Louann M. Beavers Female Date of Death Age If Veteran of U.S.Armed Forces, 11/26/2019 79 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending U Circumstances Investigation W Medical Certifier Name Title C Sean Bain MD Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 514 Burial Date Cemetery,Crematory or Facility Name 11/29/2019 Pine View Crematory Entombment Address Cremation Queensbury Town, New York Donation z Removal Date Place Removed and/or and/or Held E- Hold Address N O G. Date Point of U) ❑Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake, New York 12842 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/29/2019 Registrar of Vital Statistics F&1And'evClirtis(El6cfrardly99W (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: H Z Date of Disposition IL Z I Place of Disposition J A►- -(address) W N (section) /lot number/ (grave number/ j Y-1-.4� 0 Name of Sexton or Person in Charge of Premises le /Plea e print/Z W Signature Title �-- DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) '- 013116 Receipt Human remains of delivered on , 20_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#