Hamilton, Darlene M r.)/
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Darlene M Hamilton Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/24/2022 68 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street"Address Glens Falls Hospital
UJ
W Manner of Death ❑X Natural Cause lElAccident Homicide 0Suicide Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
Melody Long PA
Address
100 Park Street,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 391
Burial Date Cemetery,Crematory or Facility Name
07/26/2022 Pine View Crematory
Entombment Address
li1Cremation Queensbury,New York
lilDonation
OZ Removal Date Place Removed
and/or and/or Held
i Hold Address
0
O. Date Point of
(I)❑Transportation
p by Common Shipment
Carrier Destination
o
Disinterment
Date Cemetery Address
Reinterment
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
F. Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/26/2022 Registrar of Vital Statistics Megan Train(ECectronicalTySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH
Z Date of Disposition ?__z,g-�i . Place of Disposition i„e V,cmi Grt44-441rrY
UJ pi),
(address)
W
rr
N (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises 'tfrtiL)( ;Cr.S
Z (p1 se print)
IlJ Signature "54 Title} C.,(eMu r
DOH-1555(07/18)p 1 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#