Rodriguez, Brenda NEW YORK STATE DEPARTMENT OF HEALTH U Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Brenda Rodriguez Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/07/2022 57 Years _War or Dates
1,,, Place of Death Hospital,Institution or
WCity,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing
ci Manner of Death El Natural Cause ❑Accident Ei Homicide Suicide ❑Undetermined ❑Pending
V Circumstances Investigation
0ILI Medical Certifier Name Title
Shardul Koppar DO
Address
10421 State Route 40,Granville Town,New York 12832
Death Certificate Filed Town Of Granville District Number Register Number
C. ,Town or Village 5756 10
X Burial Date Cemetery,Crematory or Facility Name
(34/15/2022 Pine View Cemetery
Entombment Address
Cremation Queensbury Town,New York
Donation
Z0Removal Date Place Removed
and/or and/or Held
N Hold Address
O. Date Point of
(/)OTransportation
a by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
ElReinterment 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
H Remains are Shipped,If Other than Above
S Address
Q
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/10/2022 Registrar of Vital Statistics jenny GinaaafMarti&(Thctmnically.f'tgnwJ
(signature)
District Number 5756 Place Town Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i—
W Date of Disposition 4.t. -' a Place of Disposition 0\ C j 4, .LS D a i NJ ,p L.
2 (address)
W e II-b l
WtL ig
k (lot number (grave number)
8 Name of Sexton or Person in Charge of Premises in t C L"'6<:7a�,1 ,
Z (please pri l
W Signaturele,..144 Title �1 �i�4 fe6F.Afrb //tom
DOH-1555(o7/18)p t of 2
2b
Public Health Law Sec. 414 5( ) 1 2 907
Receipt
Human remains of delivered on - , 20 r
, Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
RODRIGUEZ LF
NAME Brenda Rodriguez Age: 57
Lot Owner: Juanita Rodriguez
Lot# Erie 11 D Grave# 1
Case: Concrete
Died: 2/7/2 0 2 2 Interred: 4/1 5/2 2
Funeral Home: Regan Denny Staff ford
Cemetery: Pine View