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Stockman, Eleanor Ann 135`1 NEW YORK STATE DEPARTMENT OF HEALTH / Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Eleanor Ann Stockman Female Date of Death Age If Veteran of U.S.Armed Forces, 12/28/2020 82 Years War or Dates E.. Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing 111 p Manner of Death IJ Natural Cause ❑Accident Homicide Suicide Undetermined ❑Pending U Circumstances Investigation 0LLJ Medical Certifier Name Title Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 231 ❑Burial Date Cemetery,Crematory or Facility Name 12/29/2020 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held __ Hold Address CO d Date Point of ft! ❑Transportation p by Common Shipment 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 p- Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/29/2020 Registrar of Vital Statistics Caroline I{t garde Barzer(EkctronicaLySWne, (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: Z Date of Disposition '2 Z1-Z)le Place of Disposition ' vZn, e_(''-yyzc" 2 (addtess) W Q (section) (lot number) /�' (grave number) GName of Sexton or Pers.• Charge of Premises Wt rvc �4c���+c! Z (please print) W Signature /f ,,// Title •� fir' "• DOH-1555(07/18)p t o 2 it.3 � 5 Public Health Law Sec. 4145(2b) , Receipt Human remains of delivered on , 20 1 1 1 Pine View Cemetery Representing the funeral home named on.burial permit Official Funeral Directors Reg.or License# Town of Queensbury * SPIIII Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Eleanor Ann Stockman were cremated on December 29 20 20 at the Pine View (Month) (Day) Crematorium, Queensbury, New York, and these are the cremated remains of said body. Date of Death December 28 20 20 Age 82 (Month) (Day) Funeral Home Regan Denny Stafford Funeral Home Registered No. 1354 ),t_je'e (Au orized Signature) STOCKMAN (LF NAME Eleanor Ann Stockman Age: 82 Lot Owner: Everett A. Stockman Lot# Erie 47 E Grave# 3 Case: Urn Died: 1 2/2 8/2020 Interred: 7/1 2/2 0 21 Funeral Home: Regan Denny Stafford Cemetery: Pine View STOCKMAN See I6V2- 1 S ` v Owner Everett A. Stockman Address Plot 42 Uncas Street, Glens Falls, NY 12804 Erie Phone # Lot # 518-793-0244 47 E C�e./i1Xf' VOP_ Deed # Date1F 4235 1 /14/2021 Cost Foundation Y - N $1500.00 Location West-Akins East-Lockhart/Vacant South-Ray North-Vacant Remarks I ACKNOWLEDGE THERECEIPT OF THE RULES AND REGULATIONS OF THE PINE VIEW CEMETERY: SIGNATURE: DATE: r44(1 / i ----6 >I SIGNATURE: DATE: Record of Interments 1 - 6 2 7 3 Now -!a-a8 a, 8 l eLtn©2 S' ( n/ 7 ,)/ c,--)r — 4 9 5 10 �i LIJ i a I i i hands_ w,�� E1.e�nee. a' a - Scivarc, r.} _ L\le,-citG e Sl �� s ov,� �Gc'c� � >/� 0 0 n to -��C.� B r Au5 , E ► a-KhGr v/ n+