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Myers, Renee 1 I NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit 'r Name First Middle Last Sex Renee Marie Myers Female Date of Death Age If Veteran of U.S. Armed Forces, r; December 21, 2015 56 War or Dates 1 Place of Death Hospital, Institution or City, Town or Village Moreau Street Address 170 Bluebird Rd.Lot 9 Manner of Death X Natural Cause i Accident I )Homicide Suicide n Undetermined Pending Circumstances Investigation Medical Certifier Name Title Robert Reeves Dr. ti= Address rtl.;;3 Irongate Center, Glens Falls,NY 12801 0 Death Certificate Filed District Number Register Number :`x City, Town or Village Moreau 4562 5-7 ❑Burial Date Cemetery or Crematory December 24, 2015 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road, Glens Falls,NY 12804 Date Place Removed Z Removal and/or Held 2 and/or Address }' Hold u) O Date Point of A. Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address r Permit Issued to Registration Number `; Name of Funeral Home Regan& Denny Funeral Home 01444 Address g: 94 Saratoga Avenue, South Glens Falls,NY 12803 r;r Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address ::: Permission is hereby granted to dispose of the human remains described above as indicated. ':dry Date Issued /49Pa / Registrar of Vital Statistics � �Z,e:-4 i/Z / cliff s (signature) era District Number 4562 Place Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z P / / Disposition �Q 1J,"e u) 6 W Date of Disposition 'Z.-23- � Place of ,� lg.yyte.,, G/y W (address) U) O (section) (lot number) (grave number) Q Name of Sexton Perso in Charge of Premises �b,,l,r`0 C.9evwf�.ci4.p `Z (please print) Signature Title e--!'einet iv P. (over) DOH-1555(02/2004)