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Velazquez, Holly Lynn NEW YORKSTATE DEPARTMENT OF HEALTH #�y Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Holly Lynn Velazquez Female Date of Death Age If Veteran of U.S.Armed Forces, 01/20/2024 51 Years War or Dates i_ Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital a Manner of Death ❑X Natural Cause Accident El Homicide ESuicide 111Undetermined El Pending W V Circumstances Investigation W Medical Certifier Name Title G Scott Biasetti 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 40 Burial Date Cemetery,Crematory or Facility Name 01/23/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York Donation ❑Removal Date Place Removed c and/or and/or Held 11 Hold Address 0 OTransportation Date Point of a by Common Shipment Carrier Destination Disinterment Date Cemetery Address LI 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 .. Remains are Shipped,If Other than Above 2 Address It wwJ O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/22/2024 Registrar of Vital Statistics 1MeganWolin(ECectronicallySigned) /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 112y IN Place of Disposition FT, N.EJ (PtnilZeTJ:,-, 2 (address) W NCC (section) I //ot number/ /grave number/ 8 Name of Sexton or Person in Charge of Premi r'› I. �MMfi (plaise print) / DJ Pcovirat Signature Title t 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#