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Bender, Paula Clarie NEW YORKSTATE DEPARTMENT OF HEALTH. Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Paula Claire Bender Female Date of Death Age If Veteran of U.S.Armed Forces, 01/16/2022 73 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital 'p Manner of Death ©Natural Cause Accident ❑Homicide ❑Suicide Undetermined Pending U Circumstances Investigation W Medical Certifier Name Title 0 Christopher Smith MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 38 Burial Date Cemetery,Crematory or Facility Name 01/18/2022 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York Donation Z ❑Removal Date Place Removed and/or and/or Held - Hold Address N O d Date Point of U) Li Transportation p by Common Shipment Carrier Destination El Disinterment 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 Remains are Shipped,If Other than Above 2 Address CC W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/18/2022 Registrar of Vital Statistics Megan Nolin(Electronically 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: W Date of Disposition i('},.1.1l).r Place of Disposition i'A e, v C.re,A r,poo/ 2 (address) W N Q (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises )cfi"es)' ,Sal,r� Z (please print) LL Signature //:07 Title C,le,4G< DOH-1555(07/18)p l of 2 _ . _. 3' 1.,F 57 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#