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Richards, Paulette M NEW YORK STATE DEPARTMENT OF HEALTH * •ti . '10 Bureau of Vital Records Burial Transit Permit ./ Name First Middle Last Sex Paulette M Richards Female Date of Death Age If Veteran of U.S.Armed Forces, 08/03/2023 74 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI p Manner of Death ❑^ Natural Cause Accident Homicide Suicide ElUndetermined ElPending fW Circumstances Investigation W Medical Certifier Name Title C Howard Silverberg 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 374 Burial Date Cemetery,Crematory or Facility Name .1 08/09/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed - and/or and/or Held t—- Hold Address N 0 a Date Point of Cl)ETransportation 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 F- Remains are Shipped,If Other than Above 2 Address CC ILI O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/08/2023 Registrar of Vital Statistics Megan.Notin(E(ectronicaCCy 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: I— Z Date of Disposition 13)ii 113 Place of Disposition 4/y,� /7) -- , fW (address) W NCC (section) / (lot number) �,,,, (grave number) 0• Name of Sexton or Person in Charge of Prer� s Z / 1,„..------ (pt se print) IliSignature / Title ( ��� DOH-1555(07/18)p i of 2 i Y r3' i Public Health Law Sec. 4145(2b) 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#