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Zetterstrom, Sylvia J
-)3 ' LOF NEW YORK STATEDEPARTMENT OF H TH 'E T EAL Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sylvia J Zetterstrom Female Date of Death Age If Veteran of US.Armed Forces, 01/19/2024 96 Years War or Dates i.,. Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing p Manner of Death IZI Natural Cause ❑Accident ❑Homicide 0 Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title O Mikram Jafri MD Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 14 Burial Date Cemetery,Crematory or Facility Name ...' 01/20/2024 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 8 Removal Date Place Removed and/or and/or Held _ H Hold Address en 0- Date Point of N❑Transportation CI Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/19/2024 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically 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: Z W Date of Disposition 11 72121 Place of Disposition FlicAr'y of M C�Js eT4--_ 2 (address) W CCCC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises fir. L ,4it z fp ase print) W Signature I)( Title 17*-70)O'P. 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 op burial permit Official Funeral Directors Reg.or License#