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Lloyd, Lauren A NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lauren A.Lloyd Female Date of Death Age If Veteran of U.S.Armed Forces, 10/01/2023 71 Years War or Dates iF— Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ❑X Natural Cause Accident El Homicide Suicide Undetermined Pending W 0 Circumstances Investigation WG Medical Certifier Name Title Kasandra Frasier 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 456 BurialE Date Cemetery,Crematory or Facility Name 10/04/2023 Pine View Crematoryy Entombment Address ©Cremation Queensbury Town,New York ▪Donation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 a. Date Point of U) Transportation p by Common Shipment Carrier Destination ODisinterment 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 1— Remains are Shipped,If Other than Above E Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/04/2023 Registrar of Vital Statistics Megan gkctronicall:y 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— W Date of Disposition 10 I SiL3 Place of Disposition r I4F„J .,,.1 G l+'►1'j 7� �w 2 (address) Hi CC CC (section) A (lot number) (grave number) CName of Sexton or Person in Charge of Pr mises — - .ii Z ) j lease print) IL Signature / Title // �1'�QJ2 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 .r':. Pine View Cemetery Representing the funeral home named on burial,permit Official Funeral Directors Reg.or License#