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Rosati, Thomasina a NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomasina Rosati Female Date of Death Age If Veteran of U.S.Armed Forces, 01/06/2021 76 Years War or Dates r Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 9 Whippoorwill Road,Queensbury Town, New York 12804 'p Manner of Death © Natural Cause ❑Accident ElHomicide ElSuicide ❑ El Pending Circumstances Investigation W Medical Certifier Name Title Jennifer Stratton MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 7 ❑Burial Date Cemetery,Crematory or Facility Name 01/11/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of (I) LiTransportation Shipment b by Common Carrier Destination Date Cemetery Address El Disinterment Date Cemetery Address El Reinterment 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 H Remains are Shipped,If Other than Above Address W 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/11/2021 Registrar of Vital Statistics Caroline?{i(fegarde Barber(ECectronicalTySigned) (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: Il— WDate of Disposition /7/-ZdZi Place of Disposition Pr).1,2 u 2 (address) W CC (scion) (lot number) (grave number) G Name of Sexton or Person in Charge of Premises �� r��` ,✓zti�� (please print/ IL Signature Title A,/,ar1 i�'`r4''' DOH-1555(07/18)p 10 2 Public Health Law Sec. 4145(2b) Q 1 4 4 0 2 Receipt Human remains of delivered on , 20 1 Pine view Cemetery w Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#