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Graham, Glenda A . , ‘..c. F NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Glenda A Graham Female Date of Death Age If Veteran of U.S.Armed Forces, 09/25/2023 77 Years War or Dates Place of Death Hospital,Institution or Liz City,Town or Village Glens Falls Street Address Glens Falls Hospital t Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending IiiCircumstances Investigation ill Medical Certifier Name Title Asim Chaudry 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 i 5601 443 Burial Date Cemetery,Crematory or Facility Name 09/27/2023 PineView Crematorium _Entombment Address ©Cremation Queensbury Town,New York Donation Z Date Place Removed or❑Removal fro and/or and/or Held Hold Address th 2 Date Point of (1)❑Transportation G by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address 18 George St Po Box 277, Fort Ann,New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom }: Remains are Shipped,If Other than Above Address te Lk# Q` Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/26/2023 Registrar of Vital Statistics Megan Nolin(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 on: F Date4 au of Disposition Zl 73 Place of Disposition �� r (address) ili (section) (lot number) a (grave number) Name of Sexton or Person in Charge of Premises /d/�/�``�l_ li W (pulse print) Signature Title JJ ���✓h�{(�� DOH-1555(07/18)p 1 of 2 i " Public Health Law Sec. 4145(2b) Receipt Human remains of ' " � 1���",') delivered on , 20 Pine View Cemetery Representing the funeral home named nz..burjai prmit Official Funeral Directors Reg.or License# '