Duffy, Donna Jean a-
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Donna Jean Duffy Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/03/2022 76 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 429 Fortsville Road,Moreau Town,New York 12831
Manner of Death l Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined Pending
W C.) Circumstances Investigation
W Medical Certifier Name Title
Anne Evans DO
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 7
EiBurial Date Cemetery,Crematory or Facility Name
02/09/2022 Pine View Crematory
❑Entombment Address
K❑Cremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d. Date Point of
(/) 11 Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
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
1— Remains are Shipped,If Other than Above
g Address
CC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/04/2022 Registrar of Vital Statistics Geea## Wcca6e(ElectronicaLySrgnei
(signature)
District Number 4562 Place Moreau, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition Place of Disposition �(1 P V1 t-,l^) (Cei)1tC.}0'
CU
2 (address)
W
Cle N (section) (lot number) (grave number)
O Name of Sexton or Person i harge of Premises Ttr ' srf
O (please print)
W Signature Title 'Coe,trio(
DOH-1555(07/t8)p t of 2
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#