Anderson, Estelle NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Estelle C. Anderson Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 25, 2014 90 War or Dates
H Place of Death Hospital, Institution or
Z City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
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Manner of Death ❑X Natural Cause n Accident n Homicide n Suicide 1-1 Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
CI Eileen Spinelli MD
Address
9 Carey Rd,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edward 5755
❑X Burial Date Cemetery or Crematory
May 9, 2014 St. Alphonsus
CI Entombment Address
❑Cremation Luzerne Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
- Hold
N
0 Date Point of
O.
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
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
Remains are Shipped, If Other than Above
Address
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0.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued y'IaS)a-1)14 Registrar of Vital Statistics yZ ' 1 "tA-k.W ,
(signature)
District Number 55'1;5 Place t o (-4 EA(3ic--L >f a
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I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 5 oil ).( Place of Disposition L.0 nice Q . 0 0-eeAS IJ.y Alf
2 _ (address)
c _LILI C) 2y 2
w (sesoti9 n) //(IIlot number) (grave number)
gName of Sexton or Person in Charge of Premises �" l (. Li i Y c
Z (please print)
W
Signature Title
(over)
DOH-1555(02/2004)