Brenenstuhl, Gail 7t ,ZZ
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gail Brenenstuhl Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/19/2022 83 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 8 Hyde Court,Queensbury Town,New York 12804
Manner of Death Natural Cause Accident Homicide ESuicide Undetermined ri Pending
W` Circumstances Investigation
W Medical Certifier Name Title
G Kristen Santos DO
Address
1401 Massachusetts Ave,Troy,New York 12180
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 183
Burial Date Cemetery,Crematory or Facility Name
11/23/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
8❑Removal Date Place Removed
and/or and/or Held __
H Hold Address
0
O. Date Point of
Cl)❑Transportation
5 by Common Shipment
Carrier Destination
EIDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
2 Address
W
0. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/23/2022 Registrar of Vital Statistics Caroline x&fegarde Barber(E(ectronicallySigned)
(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:
Date of Disposition //-Z>- z Z Place of Disposition ,JP /,Pvt/ (re i4 �n `
8J (address'
W
CC (section) (lot number) (grave number)
Name of Sexton or Person in Cha of Premis is"A 7/'h''2>
(please print)
Z
W Signature , Title OP 7t
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#