Devoe, Dorathy Cecelia 26 i
NEWYORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Dorathy Cecelia Devoe Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/20/2022 100 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,T own or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
EManner of Death El Natural Cause DAccident 0 Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
0
Medical Certifier Name Title
C Elizabeth Bessette NP
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed Town of Queensbury District Number Register Number
Cit ,Town or Village
g 5657 58
Burial Date Cemetery,Crematory or Facility Name
03/22/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
g DRemoval Date Place Removed
F and/or and/or Held
N Hold Address
N❑Transportation Date Point of
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
DReinterment
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
I— Remains are Shipped,If Other than Above
S Address
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/22J2022 Registrarof Vital Statistics Cam!'ins21d4gank Ban fer(*EGcdtmiea4'Sigtr4
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition �Zl�ZL Place of Disposition V_ � �_
2 ` (address)
W
N
Cr (section) lot number) (gram number)
S Name of Sexton or Person in Charge of Premis Allot
L .,i,iR
z (plea rind
W Signature , — Title reidliii Iif.
DOH 1555(07/18)p 1 of 2
x a
•.J
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#