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Cook, Florence Irene
4 71, Z NEW YORK STATE DEPARTMENT OF HEALTH # Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Florence Irene Cook Female Date of Death Age If Veteran of U.S.Armed Forces, 09/07/2021 97 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ©Natural Cause Ei Accident ❑Homicide 0 Suicide El Undetermined ❑Pending VCircumstances Investigation E Medical Certifier Name Title David Cunningham MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 391 ❑Burial Date Cemetery,Crematory or Facility Name 09/09/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury,New York ❑Donation g ID Date Place Removed Removal and/or Held and/or Hold Address 0 Cl)O. ❑Transportation Date Point of E' by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address -1 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom le Remains are Shipped,If Other than Above 3 Address Ili EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/09/2021 Registrar of Vital Statistics W96ertAnrfrew Curtis(E(ectronicaffy 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 11 PO/14 Place of Disposition ei f o,.,tL (ite./......... ILI 2 (address) W CA (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises a t.s Lsva„.ibc 2 /Tease print) /� �� W Signature _� Title G iP/'ciM��1�H� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Funeral Directors Reg.or License# '