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Krug, Edna Marie , LF 4 6-4) NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records ,, Name First Middle Last Sex Edna Marie Krug Female Date of Death Age If Veteran of U.S.Armed Forces, 01/11/2024 89 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 27 Kenwood Circle,Queensbury Town,New York 12804 p Manner of Death ❑X Natural Cause Accident Homicide IllSuicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title CI Jennifer Stratton MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 6 Burial Date Cemetery,Crematory or Facility Name 01/13/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z I__'Removal Date Place Removed and/or and/or Held ~ Hold Address N O O. Date Point of U)®Transportation B. Common Shipment Carrier Destination Disinterment 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 2 Address Q Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/12/2024 Registrar of Vital Statistics Caroline xl&egarckBar6er(ECectronwalTySigned) (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: ,-7 Z Date of Disposition 11,Ir 024 Place of Disposition --(SN.ikf✓ tPC-r'' 'VM.yi la 2 (address) Ill CO (section) 'J i (lot number) (grave number) gName of Sexton or Person in Charge of . es 7�A r '"'i Z (plea print) ILISignature Title f Pf 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#