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Reynolds, Laurie A
\**5:/) —701 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Laurie A Reynolds Female Date of Death Age If Veteran of US.Armed Forces, 08/31/2023 45 Years War or Dates F— Place of Death Hospital,Institution or W City,Town or Village Wilton Town Street Address 100 Gordon Lane 126,Wilton Town,New York 12831 'U p Manner of Death 1:21Natural Cause ❑Accident El HomicideSuicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title O Tammy Wheeler PA Address 15 Maple Dell 1,Saratoga Springs,New York 12866 Death Certificate Filed Town Of Wilton District Number Register Number City,Town or Village 4569 51 Burial Date Cemetery,Crematory or Facility Name 09/02/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z 11 Removal Date Place Removed Q and/or and/or Held ~ Ho N ld Address 0 Ct. Date Point of N❑Transportation zs by Common Shipment Carrier Destination Date Cemetery Address Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above a Address Q IW I). Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/01/2023 Registrar of Vital Statistics Susan Baldwin(Electronically Signed) (signature) District Number 4569 Place Town Of Wilton I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 1/5-1 Place of Disposition 2 (address) W Q (section) x(lot number/ (grave number) gName of Sexton or Person in Charge ises <— Z /sse print) W i C � ! Title (le-f✓Nld'tZ)"t Signature DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20. Pine View Cemetery Representing the funeral home named op burial permit Official Funeral Directors Reg.or License#