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Brewer, Lorna G. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Loma G.Brewer I Female Date of Death Age If Veteran of U.S.Armed Forces, 12/15/2019 88 Years War or Dates F. Place of Death Hospital,Institution or Z City,Town orViRage Glens Falls Street Address Glens Falls Hospital tp Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Lu Medical Certifier Name Title 13 Kasandra Frasier PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 536 Burial Date Cemetery,Crematory or Facility Name 12/16/2019 Pine View Cremtorium Entombment Address 0 Cremation Queensbury Hamlet,New York Donation ORemoval Date Place Removed and/or and/or Held F- Hold Address N O a Date Point of CATransportation Shipment p by Common Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom }— Remains are Shipped,If Other than Above Address Q W fL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/16/2019 Registrar of Vital Statistics RQben,4ndrew Curtis(EfectronicaffySigned) (signature) District Number 5601 Place Glens Falls, New York 1 certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 1-- Z Date of Disposition (Z I n III Place of Disposition Uj (address) W N (sec7W (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises M(Aease se print) UJ Signature /✓ Title �I2�^A'tLYL DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 13 15 E Receipt Human remains of i j delivered on f f f��-' , 20Z /r l Pine View Cemetery Representingg the funeral home"named on burial permit Official Funeral Directors Reg.or License#—� -<' ..,