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Krey, Lorraine D. NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lorraine D Krey I Female Date of Death Age If Veteran of U.S.Armed Forces, 05/11/2020 58 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Bolton Town Street Address 72 Mohican Heights Drive,Bolton Town,New York 12814 p Mannerof Death © Natural Cause Accident Homicide Suicide ❑Undetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title John Stoutenburg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Bolton Landing 5650 3 Burial Date Cemetery,Crematory or Facility Name 05/12/2020 Pine View Crematory Entombment Address FRO Cremation Queensbury Town,New York Donation Z �Removal Date Place Removed and/or and/or Held ~ Hold Address N (L Date Point of U) Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address jR Reinterment I 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 uJ a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/12/2020 Registrar of Vital Statistics 9odi G Connally(Electronically Signed) (signature) District Number 5650 Place Bolton Landing, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F W S Date of Disposition I 1 Zp Place of Disposition f` LU (address/ W U) (section/ (tot number) (grave number/ 3 0 Name of Sexton or Person in Charge of Premises rc � (pte a print/Z lW Signature �L� Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) - 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#T��