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Allen, Eva M 41 873 NEW YORK STATE DEPARTMENT OF HEALTH - • Burial - Transit Permit Bureau of VitaL Records Name First Middle Last Sex Eva M.Allen Female Date of Death Age If Veteran of U.S.Armed Forces, 09/27/2021 82 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing W Manner of Death Undetermined Pending W ©Natural Cause ❑Accident Homicide Suicide Li U Circumstances Investigation LU Medical Certifier Name Title O Leonard Gelman MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 80 ❑Burial Date Cemetery,Crematory or Facility Name 09/28/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town, New York ❑Donation o• ElRemoval Date Place Removed and/or and/or Held Hold Address 0 a Date Point of tl) 1.1 Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above 2 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/28/2021 Registrar of Vital Statistics Jenny Linda M Martelle(Electronically Signed) (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H / f►�Z Date of Disposition 41130111 Place of Disposition �„��,j i ` t a UJ (address) LLI CC N (section) (lot number) (grave number) Q Name of Sexton or Person in Charge o remises �` � S d lease print) W Signature Title 44�0` DOH-1555(07/18)p 1 of 2 ,.., n15190 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#