Bannin, Margaret NEW YORK STATE DEPARTMENT OF HEALTH il
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Margaret A. Bannin Female
Date of Death Age If Veteran of U.S. Armed Forces,
"-: February 22, 2017 78 War or Dates
f Place of Death Hospital, Institutiorirondack Tri County Nursing&
City, Town or Village Town of Johnsburg Street Address Rehab. Center
Manner of Death X Natural Cause Accident ❑Homicide n Suicide n Undetermined n Pending
41 . — Circumstances Investigation
Medical Certifier Name Title
g, Thomas Warrington RPH
Address
r% 112 Ski Bowl Rd.North Creek,NY 12853
r Death Certificate Filed District Number Register Number
`` City, Town or Village Town of Johnsburg
❑Burial Date Cemetery or Crematory
February 24, 2017 Pine View Crematorium
❑Entombment Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
H Hold
N
O Date Point of
N0 Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
`1 Permit Issued to Registration Number
> Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
- Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
R• emains are Shipped, If Other than Above
A• ddress.r s
Permission is hereby granted to dispose of the hum remains des ibe// i ove s indicated.
' — Registrar of Vital Statistics ../ ((��
Date Issued v��J ��]
`-' (signature)
District Number 5L033 Place 0 vJ
H I certify that the remains of the decedent identified above were disposed of in acco with this permit on:
ZPlace of Disposition 2171C�J r e4,t) 6,../a i�^4. >47
IL Date of Disposition yz0/1/7 (address)
ill
Cl) (section) ii /(lot number) (grave number)
Q ::t:e2 . remi5e5
Title
(over)
DOH-1555(02/2004)