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Flewelling, Lois Marie 4t2l 4 F.) NEW YORK STATE DEPARTMENT OF HEALTH , Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lois Marie Flewelling Female Date of Death Age If Veteran of US.Armed Forces, 01/03/2024 80 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Marvin Davidowitz MD Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 3 Burial Date Cemetery,Crematory or Facility Name MOM 01/08/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation • Removal Date Place Removed and/or and/or Held N Hold Address (p0Transportation Date Point of a by 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 H Remains are Shipped,If Other than Above • Address CC W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/05/2024 Registrar of Vital Statistics Wegan Wolin(Electronically Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ▪ Date of Disposition I I 121 Place of Disposition fRoF. Q70erc,4� 2 (address) W CCP(section) (tot umber) (grave number) � 8 Name of Sexton or Person in Charge of P mises } L Z It (pi se print �` W [Signature Title i4 DOH-1555(07/18)p 1 of 2 rIe:("6 Public Health Law Sec. 4145(2b) Receipt I Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#