Loading...
Russell, Beth Ann # 7S0 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Beth Ann Russell Female Date of Death Age If Veteran of U.S.Armed Forces, 03/16/2024 63 Years War or Dates Place of Death Hospital,Institution or W• City,Town or Village Glens Falls Street Address Glens Falls Hospital p• Manner of Death El Natural Cause Accident Ej Homicide Suicide Undetermined Pending Circumstances 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 160 Burial Date Cemetery,Crematory or Facility Name 03/20/2024 Pine View Crematory Entombment — Address ©Cremation Queensbury Town,New York Donation O❑Removal Date Place Removed and/or and/or Held N Hold Address O O. Date Point of CO)ETransportation 5 by Common Shipment Carrier Destination Disinterment Date Cemetery Address OReinterment 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 2 Address cc n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/19/2024 Registrar of Vital Statistics Megan No1n(E(ectronicaCCy 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 3 izt IN Place of Disposition FT-Kt/LC-0 [PEfiit „..._ ILI 2 (address) W CC N (section) 9 (lot number) (grave number) gName of Sexton or Person in Cha of Premises I r L w,.1 rt z (pl se print) W Signature Title i 0141- ' DOH-1555(07/18)p 1 of 2 r ; � r Public Health Law Sec. 4145(2b) - �4a Receipt Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#