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Page, Joanne M
NEW YORK STATE DEPARTMENT OF HEALTH ®� Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joanne M.Page Female Date of Death Age If Veteran of U.S.Armed Forces, 01/16/2024 72 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital UJ a Manner of Death EI Natural Cause Accident ❑Homicide ESuicide Undetermined ri Pending UJ Circumstances Investigation W Medical Certifier Name Title C Gamal Khalifa 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 41 RBurial Date Cemetery,Crematory or Facility Name 01/22/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held I- - Hold Address 0 O. Date Point of Cl)❑Transportation p by Common Shipment Carrier Destination O Disinterment Date Cemetery Address • ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC LU C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/22/2024 Registrar of Vital Statistics Megan Nolin(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: Z Date of Disposition )—„L5-;L.5)?i-1 Place of Disposition pint V3t 4 cr'tMccy LIJ 2 (address) W N CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises St!.�G� ,c,b 4r e,� Z (please print) W Signature /14/k Title r,f( tm trio 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#