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Atkinson, Virginia Ruth 100 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Virginia Ruth Atkinson Female Date of Death Age If Veteran of U.S.Armed Forces, 10/26/2021 95 Years War or Dates Place of Death Hospital,Institution or 1 City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending 0 Circumstances Investigation W Medical Certifier Name Title Jean Flanagan MD Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 465 Burial Date Cemetery,Crematory or Facility Name 10/28/2021 Pine View Crematory E Entombment Address 0 Cremation Queensbury,New York ❑Donation 2 Date Place Removed Removal and/or Held A and/or M Hold Address RDate Point of 0 Li Transportation 51 by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom . Remains are Shipped,If Other than Above I Address a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/27/2021 Registrar of Vital.Statistics 44.bertAndrew Curtis(ECectronicaCCy 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 Il)I Z1{Z.j Place of Disposition 7tJit— 1>_ Iti 2 (address) W Q /section/ (lot number) (grave number) 8 Name of Sexton or Person in Charge of R mises eo 44i,t /pl a r �—se print/ W, Signature Title 1agroi (/ DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt 1 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#