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Atwood, Arlene F ,N! b 7 NEW YORK STATE DEPARTMENT OF HEALTH .O Burial - Transit Permit Bureau of Vital Records ¢ '° \, Name First Middle Last Sex Arlene F Atwood Female Date of Death Age If Veteran of U.S.Armed Forces, 01/16/2024 83 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 39 Longview Drive,Queensbury Town,New York 12804 pManner of Death ❑X Natural Cause Accident EI Homicide LI Suicide FlUndetermined In Pending W Circumstances Investigation W Medical Certifier Name Title O Lynn Keil PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 12 ElBurial Date Cemetery,Crematory or Facility Name 01/18/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held NHold Address NTransportation Date Point of b by Common Shipment Carrier Destination Disinterment li 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 H Remains are Shipped,If Other than Above 5 Address R W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/18/2024 Registrar of Vital Statistics Caroline JfiCcfegarie Barber(ECectronica1Ty Signed) (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: Date of Disposition Z-Z`,1`/Placeof Disposition 0'� ,v �C' :e„L it ) ( ,^e4t,1 it'tnr1s 2 (address/ W U) Q / (section) (lot num (grave number) g Name of Sexton or Person in Charge of P ises kz y/)i©,jc kith) (please print) BJ ure A _: , /✓'/ Title C, e-4, ,� - Signal .,.,_ , b: r" DOH-1555(07/18)p 1 of 2 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# `--