Bulay, Regan Faye NEW YORK STATE DEPARTMENT OF HEALTH 47,0 g"
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Reagan Faye Bulay Female
Date of Death I Age If Veteran of U.S. Armed Forces,
10/3/2023 0 War or Dates
lF- Place of Death Hospital, Institution or
2 City, Town or Village Glens Falls Street Address Glens Falls Hospital
1 Manner of Death ❑X Natural Cause I—Accident I I Homicide Suicide ❑Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
Dr Jennifer Bashant
Address
Glens Falls,New York
Death Certificate Filed District Number Register Number 1
City, Town or Village Glens Falls,NY 5601
❑Burial Date Cemetery or Crematory
Entombment October 10, 2023 Pine View Crematorium
Address
Ni Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
ZO n Removal and/or Held
and/or Address
H Hold
O Date Point of
Nn Transportation Shipment
p by Common Destination
Carrier
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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 Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
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a. Permission is hereby granted to dispose of the human remains/ described above as indicated.
Date Issued IC7110 I Z�j Registrar of Vital Statistics C� 0).9,
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District Number 5601 Place City of Glens Falls,NY 12801
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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w Date of Disposition /0l12(23 Place of Disposition "rTNfo:E0 (141114?1M(PA-
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1Z (section) (tot number) (grave number)
pName of Sexton or Person in Ch ge of Premise At, i_ Stih nMit
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Signature Title
7
(over)
DOH-1555(02/2004)
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20_,
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#