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Musmerci, Laura June
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Laura June Musmerci Female Date of Death Age If Veteran of U.S.Armed Forces, 09/09/2021 78 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause ❑Accident 0 Homicide El Suicide El Undetermined Pending W V Circumstances Investigation W Medical Certifier Name Title Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 394 0 Burial Date Cemetery,Crematory or Facility Name 09/10/2021 Pine View Crematory Entombment Address ElCremation Queensbury Town,New York ElDonation Removal Date Place Removed 1=1 and/or and/or Held F- Hold Address 0 n. Date Point of U) ❑Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/10/2021 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: WDate of Disposition 1113111 Place of Disposition Zird�\ 2 (address) W CC N (section) 7 (lot number) (grave number) / P Name of Sexton or Person in Charge of Pre ises IL. Si-im( e print) W „ Title � ��V Signature DOH-1555(07/i8)p t of 2 • 0151 8 Public Health Law Sec. 4145(2h) Receipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#