Loading...
Parker, Georgianna P d 0 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Georgianna P. Parker Female Date of Death Age If Veteran of U.S.Armed Forces, 06/12/2023 67 Years War or Dates F., Place of Death Hospital,Institution or WCity,Town or Village Hadley Town Street Address 4129 Rockwell Street, Hadley Town, New York 12835 0 Manner of Death ❑X Natural Cause Accident ❑Homicide ESuicide FlUndetermined Pending W C.) Circumstances Investigation W Medical Certifier Name Title 0 Colleen Quinn MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Hadley District Number Register Number City,Town or Village 4558 5 Burial Date Cemetery,Crematory or Facility Name 06/19/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York Donation 0❑Removal Date Place Removed and/or and/or Held F— Hold Address UA 0 a Date Point of U)❑Transportation Shipment 0 by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above M Address Cr W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/14/2023 Registrar of Vital Statistics Colleen Demarsh(Electronically Signed) (signature) District Number 4558 Place Town Of Hadley I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— A---,L.... Z Date of Disposition (PIA(73 Place of Disposition ` i..,V_ M (address) W N , (lot number) (grave number) O (section) O Name of Sexton or Person in Charge of ices (ease print) Z 7 �'"IT‘2 W Signature Title DOH-1555(o7/18)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#