Squires, Joann Myers t
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Joann Myers Squires Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/01/2022 73 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
„p Manner of Death El Natural Cause Accident ❑Homicide Suicide Undetermined nPending
0
Circumstances II ''Investigation
W Medical Certifier Name Title
G
Asim Chaudry MD
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 599
X Burial Date Cemetery,Crematory or Facility Name
12/06/2022 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury,New York
❑Donation
❑Removal Date Place Removed
and/or and/or Held
N Hold Address
2 Date Point of
fA❑Transportation
a by Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
EiReinterment 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
-. Remains are Shipped,If Other than Above
2 Address
IZ
IW
Ct' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/02/2022 Registrar of Vital Statistics Megan Wolin(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:
Date of Disposition I o,)-L -0)a Place of Disposition o71 Lj -A't(ex2 2f £U1)-Au jSID� I aAE t
LLI
1 (address)
W C�,Pot i
in
/section/^ �/!e{number � (grave number)
G Name of Sexton or Person in Charge of Premises C I �iTh' e-
' ��`��
Z (please print/ \�,�
W Signature `' Title ��1J- I�t'l r �eJll c 1�
DOH-1555(07/18)p 1 of 2
1 .
I
Public Health Law Sec. 4145(2b)
012957
1
1 Receipt
--, ,
Human remains of I delivered on , , 20 ' \, - -- -4-'..--
-Pine View Cemetery Representing the funeral home named on burial permit
- Official Funeral Directors Reg.or License#
SQUIRES
NAME Joann Squires Age: 73 LF)
Lot Owner: Maurice & Joann Squires
Lot# Huron 20 C Grave# 1
Case: Concrete
Died: 1 2 . 1 .2 2 Interred: 1 2. 6.2 2
Funeral Home: Singleton Sullivan Potter
Cemetery: Pine View