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Podwirny, Mary E il Z NEWYORKSTATE DEPARTMENT OFHEALTHO Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary E. Podwirny Female Date of Death Age If Veteran of U.S.Armed Forces, 03/15/2024 84 Years War or Dates l— Place of Death Hospital,Institution or Z City,Town or Village Lake Luzerne Town Street Address 487 Lake Avenue Lot 10,Lake Luzerne Town,New York 12846 LLI p Manner of Death ❑X Natural Cause nAccident ❑Homicide 0Suicide FlUndetermined ❑Pending W U I—ICircumstances Investigation W Medical Certifier Name Title CI Eileen Spinelli NP Address 13 Palmer Avenue,Corinth Village,New York 12822 Death Certificate Filed Town Of Lake Luzerne District Number Register Number City,Town or Village 5656 3 Burial Date Cemetery,Crematory or Facility Name 03/25/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York ElDonation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 C- Date Point of (/) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address n 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 M Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/19/2024 Registrar of Vital Statistics Cynthia Sherwood(Electronically Signed) (signature) District Number 5656 Place Town Of Lake Luzerne I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition Sin(2N Place of Disposition rip L gc4.) C Jr►,4ltrIr-llti W M (address) W U) CC (section) (lot number) (grave number) ciName of Sexton or Person in Charge of Premises A �- /H Z (pl e print) W Signature &" i,,‘ -- Title f AS M}'f DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 g1 i Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#