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Webb, Eileen M 4. sg1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital.Records Name First Middle Last Sex Eileen M.Webb Female Date of Death Age If Veteran of U.S.Armed Forces, 07/15/2021 68 Years War or Dates Place of Death Hospital,Institution or IL! City,Town or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death ©Natural Cause 0 Accident 0 Homicide Suicide D Undetermined Pending 0 Circumstances Investigation uf Medical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 291 ❑Burial Date Cemetery,Crematory or Facility Name Entombment 07/16/2021 Pineview Crematorium Address 0 Cremation Queensbury Town,New York ❑Donation Z El Removal Date Place Removed and/or and/or Held Fes Hold Address 4 ❑Transportation Date Point of by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral.Home Mason Funeral Home 01117 Address 18 George St Po Box 277,Fort Ann,New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address CC ill CL° Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/16/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically 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: Date of Disposition 7-/7;4/ Place of Disposition r , A)e , A`re....l �'r—.,eifri,�.� } a (address) ILW CCW (section) (lot number) (grave number) • Name of Sexton or Person in o remises I<.f/yYii-J) E aOd 6 Charge (please print) Signature 19 z /Z g � Title OPe- '-u.45-i - DOH-1555(07/18)p 1 of 2 . Public Health Law Sec. 4145(2b) 014952 Receipt Human remains of delivered on , 20 f Pine View Cemetery Representing the funeral home named,:oxn bAlrial permit Official Funeral Directors Reg.or License#