Zachar, Harma L. ,t G3
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Harma L.Zachar Female
Date of Death Age If Veteran of U.S.Armed Forces
07/07/2021 95 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
W
p Manner of Death ❑X Natural Cause 1=1 Accident ❑Homicide ❑Suicide ❑Undetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
0 Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 279
Burial Date Cemetery,Crematory or Facility Name
07/09/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
0
n. Date Point of
U) ❑Transportation
Q 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
1 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 07/09/2021 Registrar of Vital Statistics R,o6ert.ilrr1rew Cunir(Ekctronicaf Signet
(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:
l— ; /
Z Date of Disposition 7ic�I o Place of Disposition �j ,J e V �,� �' �7tt�
2 (address)
W
N (section) (lot number) (grave number)
Q )
0 Name of Sexton or Person in Cha e of Premis �'"�/n��►� E ��
Z (please
print)
NJ Signature /C j Title 0 49 ej-4 r
DOH-1555(07/18)p 1 of 2
Town of Queensbury
Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Harma L. Zachar
were cremated on July , 10 20 21 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death July , 7 20 21 Age 95
(Month) (Day)
Funeral Home Regan,Denny,Stafford Funeral Home Registered No. 563
e7,04-i/j
(Authorized Signature)
ZACHAR
NAME Harma L, Zachar Age: 95
Lot Owner: John & Harma Zachar
Lot# Mohican 1 OA Grave# 2
Case: Urn
Died:7/7 2 0 21 Interred:7/2 0/2 0 21
Funeral Home: Regan Denny Stafford
Cemetery: Pine View
Public Health Law Sec. 4145(2b) - 0 1 4 9 31.
Receipt
Human remains of delivered on , 20
{
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#