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Hayes, Linda R S NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Linda R.Hayes Female Date of Death Age If Veteran of U.S.Armed Forces, 01/20/2021 75 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Undetermined Pending W © Natural Cause �Accident El Homicide �Suicide Circumstances Investigation W Medical Certifier Name Title 0 Jeremy Di Bari MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 41 ❑Burial Date Cemetery,Crematory or Facility Name 01/21/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town, New York ElDonation 0 El Removal Date Place Removed and/or and/or Held H Hold Address O O. Date Point of N ❑Transportation ES Common Shipment Carrier Destination El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 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 01/21/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically 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: t— Z Date of Disposition /—W3—; d( Place of Disposition g,c/C? U ,Pj C✓P,rn / t 1 LU (a ss) W Cl) (section) (lot number) (grave number) CC / ) 0 Name of Sexton or Person in Char of Pre ise ��/4�/�/ n) C' GD Z (please print) W Signature T g �t-,�, / Title � DOH-1555(07/18)p 1 of 2 r j Public Health Law Sec. 4145(2b) 014.447 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#