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Velazquez, Darlene Elizabeth - s-$q 17.„UF NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Darlene Elizabeth Velazquez Female Date of Death Age If Veteran of U.S.Armed Forces, 07/17/2023 84 Years War or Dates ▪ Place of Death Hospital,Institution or Z2 City,Town or Village Glens Falls Street Address 28 Harlem Street,Glens Falls,New York 12801 Manner of Death ❑ ❑Undetermined Pending � Natural Cause Accident Homicide Suicide U Circumstances Investigation Medical Certifier Name Title O Scott Miller PA 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 346 Burial Date Cemetery,Crematory or Facility Name 07/19/2023 Pine View Crematory Entombment — Address ©Cremation Queensbury,New York Donation Z Date Place Removed 0❑Removal and/or and/or Held — Hold Address N 0 0. Date Point of U)1:1Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address ri Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom • Remains are Shipped,If Other than Above Address OC W 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/18/2023 Registrar of Vital Statistics Megan Nouin(ECectronicaCCy 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 on: WDate of Disposition 7110J 13 Place of Disposition G 2 (airess/ W 1 (section) (lot number) (grave number) 8' Name of Sexton or Person in Cha of mises A� St,v_ trt Z (Ve print) W Signature Title � ��`7 DOH-1555(07/18)p 1 of 2 i I • % Public Health Law Sec. 4145(2b) 1 1 Receipt Human remains of delivered on_ , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#