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Meza, Pamela Louise g Cog$ NEW YORK STATE DEPARTMENT OF HEALTH ' '- - Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Pamela Louise Meza Female Date of Death Age If Veteran of U.S.Armed Forces, 11/05/2020 73 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 94 Sanford Street,Glens Falls,New York 12801 a Manner of Death ©Natural Cause ❑Accident ❑Homicide 12 Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title CI Donald Merrihew MD Address 319 Bay Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 499 ❑Burial Date Cemetery,Crematory or Facility Name 11/09/2020 Pine View Crematory 0 Entombment Address iCremation Queensbury Town,New York 0 Donation Q Removal Date Place Removed and/or and/or Held aHold Address 0 O. Date Point of u) ❑Transportation Shipment Q by Common Carrier Destination 0 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 i. Remains are Shipped,If Other than Above a Address cc W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/06/2020 Registrar of Vital Statistics Rp6ertAturrew Curtis(ECectronicalry Signed) (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: Date of Disposition it f 9 l 7A Place of Disposition -'VL. ilt ..... WI 2 (address) W Q (section) allot number) - (grave number) 8 Name of Sexton or Person in Charge of Premises 11, 3 o,..,�lld/ print! W Signature ���� Title 4 f'` e"ep(•• DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) O- ` i Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#