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Butler, Edna NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edna Butler I Female Date of Death Age If Veteran of U.S.Armed Forces, 12/28/2019 102 Years War or Dates F Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause Accident Homicide Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title Kasandra Frasier PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town orVittage Glens Falls 5601 563 Burial Date Cemetery,Crematory or Facility Name 12/31/2019 Pine View Crematory ❑Entombment Address ( Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed 0 and/or and/or Held N Hold Address RO Date Point of t/) ❑Transportation Shipment $ 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 ilY W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/30/2019 Registrar of Vital Statistics WpbertAndrew Curtis(Efectronically 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: W Date of Disposition 1 7-3/- /9 Place of Disposition t he..I ,Y.A,l Uj (addr s) W U) (section) 1 / (/otnumber) (grave number) O Name of Sexton or Person' ha f Premises 1 L" l t ✓' v vvi a f, / (please print) 11J Signature Title DOH-1555(07/18)p t 2 icense Public Health Law Sec. 4145(2W 013194 Receipt Human remains of delivered on , 20- ne View Cemetery Representing the funeral home named on burial permit ,.'Official Funeral Directors Reg.or License#