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Hall, Alice may
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Alice May Hall Female Date of Death Age If Veteran of U.S.Armed Forces, 12/25/2021 84 Years War or Dates F— Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide 0 Undetermined 0Pending W 0Circumstances Investigation G Medical Certifier Name Title Gamal Khalifa MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 632 ©Burial Date Cemetery,Crematory or Facility Name 12/30/2021 Pine View Crematory ❑Entombment Address ❑Cremation Queensbury Town,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held H Hold Address N (J) ❑Transportation Date Point of a by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment I: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 F— Remains are Shipped,If Other than Above 2 Address It W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/28/2021 Registrar of Vital Statistics q06ertAndrew Curtis(ECectronwa(ry Signed) (signature/ District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent1 identified above were disposed of in accordance with this permit'�on:---- Z DispositionI,.3 �� DispositioncP/ LUL�I keR�h aiff , / I W Date of Place of f� /yam/ �a�"7" (address) ` w 1-he21CeDN .023C l N cc (sed(/ 1 ro9 e(! num r) (grave number) 8 Name of Sexton o Person in Charge of Premises GV-)17 t 76 Z / S-;—/ (please printt) W Signature ~f Q G E/� Title 1CriJ 1 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012892 . . 1 Receipt , 1 il / i , l 1 \ Human remains of , i ; kit ,; " .1.'. ,, delivered o ti.illt., ,l(,.) , 20 L . , t ,Y P • f, ',... \f...)--)- N -'1 /,' \ , 'Pine View Cemetery' Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# HALL I NAME Alice May Hall � Age: 84 Lot Owner: Alice May Lot# Horicon 23 C Grave# 1 Case: Concrete Died: 1 2.2 5.21 Interred:1 2.3 0 .21 Funeral Home: Regan Denny Stafford Cemetery: Pine View