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Laurant, Juanita J
590 NEW YORK STATE DEPARTMENT OF HEALTH Burial of Vital Records - Transit Permit Name First Middle Last Sex Juanita J.Laurant Female Date of Death Age If Veteran of US.Armed Fortes, 07/20/2021 97 Years War or Dates f.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation • Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W U Circumstances Investigation WQ Medical Certifier Name Title 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 299 ❑Burial Date Cemetery,Crematory or Facility Name 07/21/2021 Pine View Crematory ❑Entombment Address X❑Cremation •Queensbury,New York ❑Donation 0 El Removal Date Place Removed and/or and/or Held N Hold Address 0 d Date Point of to ❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment ❑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 i— Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/21/2021 Registrar of Vital Statistics cP,6ert Andrew Curtis(E(ectronica1Ty 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: IF- WDate of Disposition )— ta.etc l Place of Disposition P I,ne, ,Lt,a GrPirr.9+Gfy 2 (address) W N I (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises J e,Cm e y S .rtt5 Z / (please print) lL Signature ems l Title C.re.�►�` ( DOH-1555(07/18)p 1 of 2 1 Public Health Law Sec. 4145(2b) 0 4 9 5 1 Receipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#