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Shine, Elizabeth Mary NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elizabeth Mary Shine Female Date of Death Age If Veteran of U.S.Armed Forces, 11/12/2020 92 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Fails Street Address 24 Byrne Avenue,Glens Falls,New York 12801 Manner of Death Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title Andrew Garner MD Address 8 Harrison Harrison Avenue,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 516 ©Burial Date Cemetery,Crematory or Facility Name 11/18/2020 Pine View Cemetery Entombment Address ❑Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or and/or Held pHold Address 0 G. Date Point of (I) ❑Transportation Shipment ES 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 �.. Remains are Shipped,If Other than Above g Address CC W d Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/17/2020 Registrar of Vital Statistics R9bert Andrew Curtis(ECectronicattySigned) (signature) District Number 5601 Place Glens Falls, 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 11 /18/202®lace of Disposition 21 Quaker Rd_ Queer�suy, NY 12804 ad ress `W Huron 28—A 2 ft (section) (lot number) (grave number) Name of Sexton o Person in Charge o mises Connie Goedert (please print) Ili Signature • K .1 Title Superintendent DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) 012821 Receipt Human remains of Z:. i, .. ' ' N\ , delivered on .' , 20 Pipe View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1' '` — SHINE NAME Elizabeth M. Shine Age: 92 Lot Owner: Elizabeth M. SHine Lot# Huron 28-A Grave# 2 Case: Concrete Died: 1 1 /1 2/2 0 2 0 Interred:1 /1 8/2 0 2 0 Funeral Home: Regan Denny Stafford Cemetery: Pine View