Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
White, Paula A
NEW YORK STATE DEPARTMENT OF HEALTH 4N, Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Paula A.White Female Date of Death Age If Veteran of U.S.Armed Forces, 10/30/2021 60 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Day Town Street Address 1724 N Shore Road, Day Town, New York 12835 Manner of Death ©Natural Cause Ei Accident ❑Homicide 11 Suicide Undetermined El Pending WLi C) Circumstances Investigation WD Medical Certifier Name Title John Stoutenburg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Hadley 4554 8 EiBurial Date Cemetery,Crematory or Facility Name 11/02/202i' Pine View Crematory Entombment Address ElCremation Queensbury Town, New York EiDonation Removal Date Place Removed H and/or and/or Held N Hold Address O 0- Date Point of a❑Transportation by Common Shipment Carrier Destination ElDisinterment 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 H Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/02/2021 Registrar of Vital Statistics Carol Vaillancourt(Electronically Signed) (signature) District Number 4554 Place Hadley, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition II /3 I Place of Disposition f ',,� �,�pt•` 2 (address) W U) CC (section) 4 (lot number) (grave number) 0 Name of Sexton or Person in Charge of remises StAAd Z (p e se print/ W Signature fr{�Y" g Title w AL DOH-1555(07/18)p t of 2 2 C:,tea Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20" Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#