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Gifford, Hilda J. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Hilda J Giffdrd Female Date of Death Age If Veteran of U.S.Armed Forces, 02/05/2021 67 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Lake Luzerne Town Street Address 1354 Corinth Road,Lake Luzeme Town, New York 12804 p Manner of Death © Natural Cause ❑Accident El Homicide ❑Suicide El Undetermined ❑Pending W Circumstances Investigation Q Medical Certifier Name Title Aqeel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Lake Luzerne 5656 2 Burial Date Cemetery,Crematory or Facility Name 02/06/2021 Pineview Crematory El Entombment Address 0 Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held El—F- N Hold Address 0 a Date Point of (I) ❑Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1.- Remains are Shipped,If Other than Above 2 Address W a' Permission is hereby granted to dispose of the human remains described above as indicated. 1-- Date Issued 02/05/2021 Registrar of Vital Statistics Cynthia Sherwood(Electronically Signed) (signature) District Number 5656 Place Lake Luzeme, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit IH Z Date of Disposition Z i j'I Z f Place of Disposition t L W (address) W CC (section) ( jumper) (grave number) aName of Sexton or Person in Charge of Premi 1f:•I ( -)rb^«t Z ` (please pr t)Ill /Signature Title b ^~ DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Cll.4?0 f Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#