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Bosford, Maryjoan M NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Maryjoan M.Bosford Female Date of Death Age If Veteran of U.S.Armed Forces, 09/28/2021 55 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined El Pending U Circumstances Investigation W Medical Certifier Name Title Lynn Keil PA Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 426 ❑Burial Date Cemetery,Crematory or Facility Name 10/04/2021 Pine View Crematory Entombment Address iCremation Queensbury Town, New York ❑Donation Removal Date Place Removed and/or and/or Held H Hold Address 0 O. Date Point of U) ❑Transportation CI Common Shipment Carrier Destination El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address 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 Remains are Shipped,If Other than Above g Address OC W fl' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/02/2021 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: H � Z Date of Disposition jOIS(Z( Place of Disposition � �... �r- o1�.� 2 (a dress) W CC (section) (lot number) r- lg rave number/ � 0 Name of Sexton or Person in Charge oPremises `y lease print) /- W Signature Title ( � � DOH-1555(o7/18)p t of 2 015202 Public Health Law Sec. 4145(2b) Receipt Human remains oft delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#