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Crisler, Sandra L - Q.- ---F\ •WIOV) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sandra L Crisler Female Date of Death Age If Veteran of U.S.Armed Forces, 12/23/2023 81 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 26 Clark Street,Queensbury Town,New York 12804 W Manner of Death g ID �Natural Cause Accident Homicide Suicide Undetermined �Pendin W Circumstances Investigation W Medical Certifier Name Title O Paul Filion MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 Burial Date Cemetery,Crematory or Facility Name 12/26/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation O❑Removal Date Place Removed - and/or and/or Held F-- Hold Address N 0 O. Date Point of Cl) Transportation Shipment 5 by Common 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 1 Address Lt W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/26/2023 Registrar of Vital Statistics Caroline 2fi&Qegarie Barber(ECectronicallySigned) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I-, W Date of Disposition /2-77- ?Oe3 Place of Disposition I'� ^-I C ��e e dd s/-.1 2 W U) EIC (section) (lot num rl (grave number) SName of Sexton or Person in Charge f Prem. es eta 4i10--) � Z rplease print) W Signature L 7% Title i �a DOH-1555(07/18)p 1 of 2 n1 7 790 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#