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Corcoran,Amy Lynn 1037 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Amy Lynn Corcoran Female Date of Death Age If Veteran of U.S.Armed Forces, 11/27/2021 51 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Bolton Town Street Address 260 S Trout Lake Road,Bolton Town, New York 12824 p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide Ei Undetermined Pending W Circumstances Investigation WMedical Certifier Name Title 0 Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Bolton Landing 5650 16 ❑Burial Date Cemetery,Crematory or Facility Name 12/06/2021 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York ElDonation ZO Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 a Date Point of co j Transportation Shipment by Common 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 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 12/01/2021 Registrar of Vital Statistics 9oI Petteys(E(ectronica1CySigned) (signature) District Number 5650 Place Bolton Landing, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition ILO 114 Place of Disposition rn c‘L.• ADC (address) W CC (section) /J (lot number) (grave number) 8 Name of Sexton or Person in Charge o remises t!s Soil ` 71 Z (plea a print) W Title ref",►'f(dui Signature DOH-1555(07/18)p 1 of 2 } 01_5e't0 t 7 Public Health Law Sec. 4145(2b) Receipt Human remains of - delivered on , 20 Pine View Cemetery Representing the funeral home named on burial_permit Official Funeral Directors Reg.or License#