Loveland, Regina M NEW YORK STATE DEPARTMENT OF HEALTH i
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Regina M. Loveland Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/19/2022 60 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
p Manner of Death i Natural Cause IllAccident I I Homicide Suicide Undetermined ❑Pending
W Circumstances Investigation
WMedical Certifier Name Title
CI Abigail Macomber PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 480
Burial Date Cemetery,Crematory or Facility Name
09/24/2022 Pine View Crematory
Entombment Address
▪Cremation Queensbury Town, New York
▪Donation
o❑Removal Date Place Removed
and/or and/or Held
H Hold Address
t)
0
O. Date Point of
U)❑Transportation
p by Common Shipment
Carrier Destination
o
Disinterment
Date Cemetery Address
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home Inc 00211
Address
24 Church Street PO Box 500, Lake Luzerne,New York 12846
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
LE
W
0. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/20/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(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:
~ e✓`-.
Z Date of Disposition I in I j2 Place of Disposition �,u�l, / r
W
2 (address)
W
U)
O(section) � '(lot number) (grave number)
p Name of Sexton or Person in Charge o r mises � 1
Z (prA?se print)
W lr*rna�i7
Signature Title
DOH-1555(07/18)p 101 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#