Hoey, Beverly J. # 26
NEWYORKSTATEDEPARTMENTOFHEALTH *+ . Burial - Transit Permit
Bureau of Vital Records i
Name First Middle Last Sex
Beverly J.Hoey Female
Date of Death Age If Veteran of U.S.Armed Forces,.
03/01/2021 86 Years War or Dates
., 1.. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
1111
p Manner of Death El Natural Cause ❑Accident ❑Homicide 0 Suicide ❑Undetermined ❑Pending
W iJ Circumstances Investigation
-..
ILI
0 Medical Certifier Name Title
Thomas Williams MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 134
0 Burial Date Cemetery,Crematory or Facility Name
03/09/?021 Pine View Crematory
0 Entombment Address
ICremation Queensbury Town,New York
❑Donation
OZ ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
d) ❑Transportation
a by Common Shipment
Carrier Destination
El 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
F— Remains are Shipped,If Other than Above
a Address
CC
tZ Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/09/2021 Registrar of Vital Statistics RpaertAufrewCurtic(Electronicaffy'Srgne42
(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:
Z Date of Disposition 311i 171 Place of Disposition `IL Z'_.__
ui address)
W
CO
CC (section) (lot numb") (grave number)
Name of Sexton or Person in Charge of Premi s n t,,-1"I'� ,wi-
Z (please print)
W Signature �� Title (R4,e}ik
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 1146,1'9
Receipt
Human remains of delivered on , 20
1
I Pine View Cemetery Official Representing the funeral home named on burial permit
Funeral Directors Reg.or License#
1