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Hickey, Judith R
14,:f) -ft Si S— NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Judith R Hickey Female Date of Death Age If Veteran of U.S.Armed Forces, 06/22/2023 82 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death El Natural Cause Accident El Homicide ESuicide FlUndetermined riPending W Circumstances Investigation Medical Certifier Name Title Marvin Davidowitz 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 307 Burial Date Cemetery,Crematory or Facility Name 06/26/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of (I) Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 2 Address IIC • Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/23/2023 Registrar of Vital Statistics Megan Trolin(Electronically Signed) (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 one: W Date of Disposition �j� n(t3 Place of Disposition 2 (address) W (section) (lot number) (grave number) ff 0 Name of Sexton or Person in Charge of Premises (pp ase print) Z iere W Signature Title DOH-1555(07/18)pi 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#