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Floyd, Glenda I NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Glenda I Floyd Female Date of Death Age If Veteran of U.S.Armed Forces, 01/31/2021 73 Years War or Dates i_ Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p▪ Manner of Death XI Natural Cause Accident El Homicide ❑Suicide Undetermined ❑Pending ✓ Circumstances Investigation 0ILI Medical Certifier Name Title Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 72 ©Burial Date Cemetery,Crematory or Facility Name 02/05/2021 Pine View Cemetery ❑Entombment Address ❑Cremation Queensbury Town,New York ❑Donation goRemoval Date Place Removed and/or and/or Held pN Hold Address 0 a Date Point of U) ❑Transportation ES by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above a Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/02/2021 Registrar of Vital Statistics i4,6ertAndrew 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: F- Z Date of Disposition 2/5 /7 0 21 Place of Disposition 21 Quaker Rd Queensbury, NY 12804 W 2 (address) W Erie 1 3 R 1 CC (section) (lot number) (grave number) SName of Sexton r Person in Charge of Premises Connie Goedert Z (please print) W Signature Kira-- e -e Title Superintendent DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012842 Receipt Human remains of r. y `_: delivered on : ;', 20 J .j r , Pine View CeWeete}y Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# FLOYD NAME Glenda I Floyd LF Age: 73 Lot Owner: Glenda Floyd Lot# Erie 13 B Grave# 1 Case: Concrete Died: 1 /31 /2 0 21 Interred: 2/5/2021 Funeral Home: Regan Denny Stafford FH Cemetery: Pine View