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Eggleston, Geraldine LF NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Geraldine Rachael Eggleston Female Date of Death Age If Veteran of U.S.Armed Forces, 11/30/2020 51 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital pManner of Death ©Natural Cause El Accident EiHomicide ❑Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title G Tara Fitzgerald NP Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2626 ©Burial Date Cemetery,Crematory or Facility Name 12/08/2020 Pine View Cemetery ElEntombment Address Cremation Queensbury Town,New York ElDonation • Removal Date Place Removed O and/or and/or Held F- Hold Address N O Date Point of U)❑Transportation Shipment Q by Common Carrier Destination Date Cemetery Address ElDisinterment 1=1Reinterment 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 2 Address Q W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/02/2020 Registrar of Vital Statistics EDanielle S Gi(tespie(E(ectronica4Cy Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 1 2/8/2 0 2 0 Place of Disposition 21 Quaker Rd Queensbury, NY 12804 W (address) WHoricon 6 1 1 Q (sedion) (lot number) (grave number) g Name of Sexton Person in Charge Premises Connie Goedert (please print) W SignaturefLAL ¢- Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012826 Receipt r Human remains of-4 ._. 4 `:, , delivered on > , 20_�.: sj Pine View Cemetery Representing tie funeral home named on burial permit Official Funeral Directors Reg.or License# 1 Nl 4 EGGLESTON NAME Geraldine Eggleston Age: OBI Lot Owner: Geraldine Eggleston - DSS Lot#Horicon 6 i Grave# 1 Case: concrete Died:1 1 /3 0/2020 Interred:1 2/8/2 0 2 0 Funeral Home: Regan Denny Stafford Fh Cemetery:Pine View