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Blais, Sheila G - L-F ti 3 37 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sheila G.Blais Female Date of Death Age If Veteran of U.S.Armed Forces, 04/12/2023 83 Years War or Dates IH Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death El Natural Cause Accident El Homicide ESuicide FlUndetermined El Pending W Circumstances Investigation W Medical Certifier Name Title CI David Cunningham 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 190 Burial Date Cemetery,Crematory or Facility Name 04/14/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York .0Donation o❑Removal Date Place Removed *- and/or and/or Held to Hold Address 0 4 Date Point of (/ID TransportationShipment Q by Common Carrier Destination ❑Disinterment Date Cemetery Address tIReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address i 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom E Remains are Shipped,If Other than Above 2 Address 11 111 a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/13/2023 Registrar of Vital Statistics Megan Yolin gYectronica15'Srgned) (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: H � 24-- Z Date of Disposition �ly�jj [ /,,ti Place of Disposition <<— ILI (address) W CCCC (section) (lot number) ` _ (grave number) SName of Sexton or Person in Charge of P mises it Z y ( ase print)W Signature Title lnJAW DOH-1555(o7/18)p 1 of 2 / a8 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#