Viele, Florence NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Florence E. Viele Female
Date of Death Age If Veteran of U.S. Armed Forces,
. September 8, 2012 86 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Deathiyi 1771Natural Cause ❑Accident n Homicide n Suicide n Undetermined n Pending
Lii Circumstances Investigation
Medical Certifier Name Title
P. (.- 0-4(v- c_\ c..Jx l
' Address
Death Certificate Filed t ,, ,,istrict Number Register Number
City, Town or Village Glens Falls 5601 Li 1 0
®Burial Date Cemetery or Crematory
C,
Ill Entombment 1 \ t1- St. Alphosus Cemetery
Address
❑Cremation Pine Street, Queensbury,NY 12804
Date Place Removed
ZO T Removal and/or Held
and/or Address
—I— Hold
N
0 Date Point of
Nn Transportation Shipment
El by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
I
Permit Issued to Registration Number
Name of Funeral Home Sullivan-Minahan& Potter 01646
Address
407 Bay Road,Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
aM° Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described abovg as indicated.
Date Issued 9 1 i 0 /i Z Registrar of Vital Statistics We.A.A.iy-..L W
(signaJ� tills)
District Number 5601 Place Glens Falls) t j y
I certify that the remains of the decedent identified above were disposed of in accords ce with t ' ermit on:
I— P►n Q S4- e srr !� A'a YO'I
W Date of Disposition I rA r Place of Disposition ,� el
2 (address)
CA W D 13-1 1
rt (se on) A lot number) (grave number)
pName of Sexton or Person in Charge of Premises et,....‘ L�
Z (please print)
W Signature Q Title MINNA V 41
(over)
DOH-1555(02/2004)