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Dolan, Edith K. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edith K.Dolan Female Date of Death Age If Veteran of U.S.Armed Forces, 10/23/2020 94 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 225 Cronin Road,Queensbury Town,New York 12804 0 Manner of Death ❑X Natural Cause Accident Homicide Suicide ❑Undetermined El Pending W Circumstances Investigation U W Medical Certifier Name Title 0 Sharon Shannon NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 198 ©Burial Date Cemetery,Crematory or Facility Name 10/28/2020 Pine View Cemetery Entombment Address Cremation Queensbury,New York Donation z ❑Removal Date Place Removed and/or and/or Held y Hold Address 0 0. Date Point of U) 11 Transportation Shipment Q by Common 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 or to Whom 1— Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/26/2020 Registrar of Vital Statistics Caroliinexl21egard Barbirgkctronicall:y Signed) (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: I— W Date of Disposition 10/28/202RIaceofDisposition 21 Quaker Rd. Queensbury, NY 12804 (address) Liii Uncas Sec. 22 Lot # 1061 ; 5 CC CC (section) (lot number) (grave number) 0 Name of Sexton o erson in Charge of P emises COnni e GOedert � �'►1/ (please print) W Signature e Title Superintendent DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012817 Receipt _ I Human remains of,/ -, i . -1 - f ‘.k , I delivered on ,-- :'f- „,, , / e . I ' , (i , (.--I, - Pine View Cenuitery Representing the ftral home named on burial permit Official ' / Funeral Directors Reg.or License# k c74 411 -- DOLAN NAME Edith Dolan Age: 94 Lot Owner: John T. / Thomas E. & Edith M. Dolan Lot# Uncas Sec. 22 Lot # 1 061 Grave# 5 Case: Concrete Died: 10/23/2020 Interred.) Funeral Home: Regan Denny Stafford Cemetery: Pine View