Collins, Heidi NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Heidi Ann Collins Female
Date of Death Age If Veteran of U.S. Armed Forces, n/a
October 31,2017 64 War or Dates
E„ Place of Death Hospital, Institution or
Z City, Town or Village South Glens Falls,NY Street Address 129 Saratoga Ave
pManner of Death X Natural Cause Accident [1 Homicide Suicide n Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Daniel Kuhn,Coroner
Address
Ballston Spa,NY
Death Certificate Filed District Number Register Number
City, Town or Village South Glens Falls,NY 4524 /5
❑Burial Date Cemetery or Crematory
November 3,2017 Pine View Crematory
❑Entombment Address
IN Cremation Quaker Road,Queensbury,NY
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
O.
n Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter 01596
Address
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I. Remains are Shipped, If Other than Above
2 Address
W
W
a. Permission is hereby granted to dispose of the human remains cribed abov as in iicated.
Date Issued /1-3-" 17 Registrar of Vital Statistics (�C
(signature)
District Number 5,-Y Place V t`fctG 50-utkc3b/A ‘a/la
I certify that the remains/of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition /I/31 n Place of Disposition FA*iL.' A.1vior..,.
Ili
(address)
CO
0 (section) / (lot number) - (grave number)
QName of Sexton or Person in Charge of Premises j/i/ js 1r1,t
Z ( ease print9
uu
li Signature Title ili(MOW,
(over)
DOH-1555(02/2004)