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Teeter, Laura M. # Sol NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Laura M.Teeter Female Date of Death Age If Veteran of U.S.Armed Farces, 05/02/2020 90 Years War or Dates ZPlace of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre p Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending U Circumstances Investigation Q Medical Certifier Name Title Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 89 ❑Burial Date Cemetery,Crematory or Facility Name 05/04/2020 Pine View Crematory Entombment Address ICremation Queensbury Town, New York ❑Donation 0 Removal Date Place Removed and/or and/or Held (- N Hold Address O I- Date Point of (n Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W I' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/04/2020 Registrar of Vital Statistics Q3d1wHi1agardeB3 T(EledravdlyS9W (signature) District Number 5657 Place Queensbury, 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 J r"b-2D20 Place of Disposition R'h e ()j"27 J 6re zJv Uj (address W N W (section) i (lot number) (grave number) GName of Sexton or Person in C 7ge Premises l G-✓t ��W "L Z (please print) W Signature Title �r�'rqaTir L, G DO H-1555(o7/18)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#