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Howard, Michelle J. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Michelle J Howard Female Date of Death Age If Veteran of U.S.Armed Forces, 03/15/2021 55 Years War or Dates Place of Death Hospital,Institutionor Z City,Town or Village Queensbury Town Street Address 8 Treasures Place,Queensbury Town, New York 12804 Manner of Death Undetermined Pending W © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ ❑ Circumstances Investigation W Medical Certifier Name Title CI Robert Love MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 70 ❑Burial Date Cemetery,Crematory or Facility Name 03/18/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed pand/or and/or Held N Hold Address 0 a Date Point of V) LiTransportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment 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 5 Address W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/18/2021 Registrar of Vital Statistics Caroline Jfi&Iegarrfe Barber(Efectronica1CySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /11 Z 11.1 Date of Disposition 3)i 81 Z i Place of Disposition 2 (address) W CC (section) A (lot nnuumbe (grave number) 0 Name of Sexton or Person in Charge of Premises `/ r�` """"�� (plase print) W Signature Title / ?F'vtIVX DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014846 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#