Cassidy, Genevieve NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
GENEVIEVE F. CASSIDYY Female
Date of Death Age ' If Veteran of U.S. Armed Forces,
April 28, 1994 70 War or Dates None
p Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls, NY Street Address GLens Falls Hospital
Manner of Death Natural Cause D Accident 0 Homicide 0 Suicide 0Undetermined El Pending
thil Circumstances Investigation
Medical Certifier Name Title
Patricia L. Hale, M.D.
"iiiii' Address
7240 Broadway Fort Edward, NY 12828
Death Certificate Filed District Number Regi ter Number
. City, Town or Village Glens Falls, NY ) 5601 37
Date Cemetery or Crematory
®Burial May 2, 1994 St. Alphonsus Cemetery
Address
L_I Cremation
ueensbur NY
FDate Place Removed
Z❑Removal , and/or Held
tt and/or Address
Hold
Q Date I Point of
Q Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
ki Permit Issued to Registration Number
ft Name of Funeral Home James F. Singleton, Inc. 01807
Address
314 Bay Road Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
W
1
Pnrrnissinn es h°reby Crarttecl to dicpcs? -f"e hCSr'.:... .' w...'ns 4^^^.'.w '"c GI ^ 'rurd ` d
Val
Date Issued Apr 29, 1994 Registrar of Vital Statistics .^ '/"-tM„o,
(signature)
District Number 5601 Place City of Glens Falls, NY 1 7801
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
!rr Luzerne Rd. & Pine St.
Date of Disposition 5/2/94 Place of Disposition St. Alphonsus Cemetery, Queensbury, NY 12804
2 (address)
N3 grave section, Row 0 21 so. half 1
0 M (section) (lot number) (grave number)
Name of Sexton or Person in Charge Premises Rev. Robert W. Powhida
g • ,24.-4 V / (please print)
Signature (,,/• � Title Pastor
DOH-1555 (10/89) p. 1 of 2 VS 61