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Young, Shelia Marie -1HZ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sheila Marie Young Female Date of Death Age If Veteran of U.S.Armed Forces, 09/01/2021 69 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Hudson Falls Village Street Address 22 East LaClaire Street,Hudson Falls Village,New York 12839 • Manner of Death © Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Titlt Christopher Mason DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 5726 24 Burial Date Cemetery,Crematory or Facility Name 09/03/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held N Hold Address 0 a 1-1 Date Point of to ❑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 2 Address CC • W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/02/2021 Registrar of Vital Statistics Cynthia Bardin(ECectronica1Ty Signed) (signature) District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 9-��; Q,�� Place of Disposition P lie its� Cr€,r 4-lt!t (address/-.J W N (section) / (lot number) (grave number) 0 Name of Sexton or Person in Cha e of Premise �����C 6 (� ®� Z / ( ease print) 481-5- ul Signature p f y Title 010-ffki. DOH-1555(07/18)p t of 2 ra Public Health Law Sec. 4145(2b) &.5108 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#