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Kane, Elizabeth A. Z32 s NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elizabeth A Kane Female Date of Death Age If Veteran of U.S.Armed Forces, 02/27/2021 82 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital CI Manner of Death Natural Cause Accident 1=1Homicide Suicide Undetermined Pending V © Circumstances Investigation W Medical Certifier Name Title G Jennifer Stratton MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 123 Burial Date Cemetery,Crematory or Facility Name 03/02/2021 Pine View Crematory Entombment Address Cremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held H Hold Address Ut LiTransportation Date Point of 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 H Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/02/2021 Registrar of Vital Statistics Pp6ert 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: Date of Disposition 3/3 / Zj Place of Disposition W a( (address) W CC (section/ / (tot number) (grave number) 0 Name of Sexton or Person in Charge of Premises . • �' ,""'' � (,tease print) lL Signature Title �► '"�}TWt DOH-1555(07/18)p i of 2 la" Public Health Law Sec. 4145(2b) 014599 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#