Bird, Sharon M (LF. # -ix
NEWYORKSTATEDEPARTMENTOFHEALTH �� Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sharon M Bird • Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/26/2022 80 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 48 New Hampshire Avenue,Queensbury Town,New York 12804
p Manner of Death III Natural Cause Accident Homicide ESuicide nUndetermined ElPending
W
V Circumstances Investigation
W Medical Certifier Name Title
0 Aqeel Gillani MD
Address
, 100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 138
Burial Date Cemetery,Crematory or Facility Name
09/28/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
CO
0
O. Date Point of
CO❑Transportation Shipment
Q by Common
Carrier Destination
o
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
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
a Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/28/2022 Registrar of Vital Statistics Caroline glififegarde Barber(ECectronicalySigned)
(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:
H 674____
Z Date of Disposition q 13o h 1,1 Place of Disposition F W /a dress)
W
CCCC (section) 3 rlfotnumber) (grave number)
tti8 Name of Sexton or Person in Cha of Premises 1
(p ase print)
W Signature Title
DOH-1555(07/18)p 1 of 2
;ray :; 3
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#