Manell, Cheryl Ann �t �l
NEW YORK STATE DEPARTMENT OF HEALTH
�
L-(....:...---- - Burial - Transit Permit
Bureau of Vital Records .
Name First Middle Last Sex
Cheryl Ann Manell Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/04/2022 68 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 36 Thomson Avenue,Glens Falls,New York 12801
LIJ
p Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
W
C.) Circumstances Investigation
W Medical Certifier Name Title
0 Michael Adams MD
Address
1299 9 Route,Gansevoort Hamlet,New York 12831
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 455
Burial Date Cemetery,Crematory or Facility Name
09/07/2022 Pine View Crematory
[]Entombment Address
[ ]Cremation Queensbury,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
a Date Point of
(/)❑Transportation Shipment
0 by Common
Carrier Destination
Disinterment Date Cemetery Address
0 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
H Remains are Shipped,If Other than Above
a Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/07/2022 Registrar of Vital Statistics MeganWofin(EfectronicaltySigned)
(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:
H
Z Date of Disposition q I81ZZ Place of Disposition ,lt.V" A _
111 (address)
W
NCC (section) X Rot number) (grave number)
0 Name of Sexton or Person in Charge/remises IN 4(..., 4 tr
z ase print) /
W Signature Title ate(kick
DOH-1555(07/18)p 1 of 2
ti` t� 7
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#