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Siano, Tara I NEW YORK STATE DEPARTMENT OF HEALTH � ffll' Burial - Transit Permi Bureau of Vital Records Name First Middle Last Sex Tara I.Siano Female Date of Death Age If Veteran of U.S.Armed Forces, 02/23/2024 51 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ❑^ Natural Cause Accident []Homicide ESuicide []Undetermined ❑Pending tL C.) I 1Circumstances Investigation W Medical Certifier Name Title 0 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 112 HBurial Date Cemetery,Crematory or Facility Name 02/26/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York Donation Z Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 d Date Point of Cl) Transportation Q by Common Shipment Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address Reinterment 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 1— Remains are Shipped,If Other than Above 5 Address It W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/26/2024 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: I— Z Date of Disposition ?WWII Place of Disposition Pz,�E✓T,rt:4 ek,,F onr4tvtt—th` 1!J (address) W Nit (section) �/I (lot numb (grave number/ gName of Sexton or Person in Ch of Premises �'� �— Al Z (please pnn �/ ,J� ��� W Signature Title AlIS n DOH-1555(07/18)p 1 of 2 yi r 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#