Ball, Brenda Lee NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Brenda Lee Ball Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/07/2021 62 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Albany Street Address Albany Medical Center Hospital
IL
Manner of Death ❑X Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined Pending
0 Circumstances Investigation
Q Medical Certifier Name Title
Alan Vela
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 1713
ElBurial Date Cemetery,Crematory or Facility Name
07/09/2021 Pine View Crematory
❑Entombment Address
iCremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
)—
N Hold Address
0
d 1-1
Date Point of
co Transportation
p 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
▪ 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 07/08/2021 Registrar of Vital Statistics DanW&Scillerpie(!Yectronicall:ySigned
(signature)
District Number 0101 Place Albany, 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 � it(ti Place of Disposition RIZ1'` n-
2 (address)
W
N
CC (section) (tot number) (grave number)
GName of Sexton or Person in Charge of Pre ' es t•� � SA4n
z tease print/
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01. C 34
Receipt
Human remains of delivered on , 20
{
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#