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Collazo, Emily Rose (_--- .4 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Emily Rose Collazo Female Date of Death Age If Veteran of U.S.Armed Forces, 12/05/2023 61 Years War or Dates l— Place of Death Hospital,Institution or Z City,Town or Village Hadley Town Street Address 459 Parker Road, Hadley Town,New York 12835 pManner of Death ❑^ Natural Cause Accident El HomicideSuicide Undetermined Pending U Circumstances Investigation W Medical Certifier Name Title CI Susan Hayes-Masa Coroner Address 40 McMaster Street,Ballston Spa Village, New York 12020 Death Certificate Filed Town Of Hadley District Number Register Number City,Town or Village 4558 8 Burial Date Cemetery,Crematory or Facility Name 12/11/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York ▪Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 4. Date Point of Cl)DTransportation 0 by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom f— Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/11/2023 Registrar of Vital Statistics Colleen Demarsh(Electronically Signed) (signature) District Number 4558 Place Town Of Hadley I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition /7/Z-Z 23 Place of Disposition rJ e It.e,,J C(-e-pi,-5.r'--s 1 J (address) W N IE (section) (lot number (grave number) - di 0 Name of Sexton or Person in Charg f Prem. s /4/a.J tIV Z (please print) W Signature ,ti/-"41/4-2 Title ‘,pc er4--46 DOH-1555(o7/18)p id 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 Official Funeral Directors Reg. or License#