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Knapp, Gail M r ..t) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gail M.Knapp Female Date of Death Age If Veteran of U.S.Armed Forces, 03/05/2023 75 Years War or Dates . Place of Death Hospital,Institution or IL1 City,Town or Village Glens Falls Street Address Glens Falls Hospital Q Manner of Death 1=1NaturalCause Accident Homicide OSuicide Undetermined ❑Pending W U Circumstances Investigation ; ©, Medical Certifier Name Title Christopher Smith 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 118 Burial Date Cemetery,Crematory or Facility Name ® 03/06/2G&3 Pineview Crematorium _Entombment Addresq ©Cremation Queensbury Town,New York Donation • so Removal Date Place Removed and/or and/or Held - Hold Address V) 0 A. Date Point of 1)❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address 18 George St Po Box 277,Fort Ann, New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom }.. Remains are Shipped,If Other than Above Address IC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/06/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed) (signature) District Number 5601 Place City Of Glens Falls 1 certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition h 11,4 Place of Disposition IL (address) RI ft (section/ ,:p Lot number) (grave number) Name of Sexton or Person in Charge of Premises - � rtl (please print/ t11 Signature Title (r-outIva DOH-1555(07/18)p 1 of 2 F 11. 1 a: 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#