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Senneville, Sally Ann 0 / 1..... _ 4 s NEW YORK STATE DEPARTMENT OF HEALTH ' Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sally Ann Senneville Female Date of Death Age If Veteran of U.S.Armed Forces, 11/18/2023 73 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital O Manner of Death 1ZINatural Cause Accident Homicide El Suicide FlUndetermined El Pending W Circumstances Investigation W Medical Certifier Name Title G Shahid Ahmed 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 537 Burial Date Cemetery,Crematory or Facility Name 11/21/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed - and/or and/or Held F-- Hold Address (/) 0 O. Date Point of to❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Wilcox&Regan 01821 Address 11 Algonkin St,Ticonderoga, New York 12883 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above a Address C W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/20/2023 Registrar of Vital Statistics 9ilegan.No(in(E(ectronica((ySigned) (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— Date of Disposition II-2,e— c- T3 Place of Disposition );pc V')Ly j Gic,mcj.#sry 2 (address) W N (section) (lot number) (grave number) g Name of Sexton or Person in Charge of Premises -3;c1Nty S`ry,t.t,s (please print) IU Signature 44r Title Cfem4kr DOH-1555(07/18)p 1 of 2 � „7 - 7 Public Health Law Sec. 4145(2b) ' • Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit C7ffieial Funeral Directors Reg.or License#