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Hall, Loretta I NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Loretta Hall Sex Female Date of Death Age If Veteran of U.S.Armed Forces, 03/24/2023 69 Years War or Dates Place of Death Hospital,Institution or City,Town or Village1=1 Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing Manner of Death Medical Certifier Natural Cause Accident Homicide Suicide Undetermined ❑I—IPending Circumstances Investigation Name Title Jennifer Donovan DO Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 42 Burial Date Cemetery,Crematory or Facility Name 03/27/2023 Pineview Crematory Entombment Address ,,-. ©Cremation Queensbury Town,New York ❑Donation b,1 Removal Date Place Removed and/or and/or Held Hold Address ❑Transportation Date Point of by Common Shipment i Carrier Destination -4- Disnterment ry Date Cemete Address il i , Date Cemetery Address Reinterment Ai 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 Address �" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/27/2023 Registrar of Vital Statistics Caroline 2{z[degarde Barber(E(ectronica1Cy Signed) (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: gDate of Disposition 311i 173 Place of Disposition X (address) ill CO CC (section) i (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises, A .'he/L— Lami'I /ptPase print/ Signature Title d IZ` 'irv4 41 DOH`1555(07/18)p 1 of 2 0 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#