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Lloyd, Victoria Jean
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Victoria Jean Lloyd Female Date of Death Age If Veteran of U.S.Armed Forces, 03/28/2020 78 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Thurman Town Street Address 860 High Street,Thurman Town,New York 12810 Manner of Death ©Natural Cause Accident Homicide ❑Suicide Undetermined Ej Pending Circumstances Investigation WMedical Certifier Name Title 0 Suzanne Bergin DO Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Athol 5659 0002 ❑Burial Date Cemetery,Crematory or Facility Name 03/31/2020 Pine View Crematory Entombment Address X❑Cremation Queensbury,New York ❑Donation Removal Date Place Removed and/or and/or Held N Hold Address O 9L Date Point of ❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑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 orto Whom I—. Remains are Shipped,If Other than Above Address IQ W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/31/2020 Registrar of Vital Statistics Susan Stapfes(EfectronicaCCy Signed) (signature/ District Number 5659 Place Athol, New York t I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition ) ZO Place of Disposition Rol 4ft--. 2 (address) W Ix (section) (lot number) (grave number) SM 4� Name of Sexton or Person in Charge of P mises Z (pl se print) �,�,,�_ W Signature Title /tic, T� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of ' "' delivered on , 20 Pine Vic*Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# '1