Earls, Stephanie Y � 16
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Stephanie Y Earls Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/02/2022 36 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Schenectady Street Address 450 McClellan Street,Schenectady,New York 12304
W Manner of Death
WLirlNatural Cause Accident 0 Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
WO Medical Certifier Name Title
Bernard Ng MD
Address
1101 Nott St.,Schenectady,New York 12308
Death Certificate Filed District Number Register Number
City,Town or Village Schenectady 4601 8
ElBurial Date Cemetery,Crematory or Facility Name
01/06/2022 Pineview Crematory
0 Entombment Address
lCremation Queensbury Town,New York
0 Donation
Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
a- Date Point of
N Li Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
}— Remains are Shipped,If Other than Above
2 Address
Q
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/05/2022 Registrar of Vital Statistics Samanta R.Mykoo(Electronically Signed)
(signature)
District Number 4601 Place Schenectady, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
WDate of Disposition I /) l Z Z Place of Disposition r � E t,__
(address)
Ui
2 (section) /� ((t number/c (grave number)
0 Name of Sexton or Person in Charge of mises C � n-1 L t f
Z /pse print) �/�
W fee
Signature ��_ Title ` ��"'V"1'`-
DOH-1555(07/18)p 1 of 2
'79
I Public Health Law Sec. 4145(2b)
1_ 5 �
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#