Abbott, Janet NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Janet Carolyn Abbott Female
` Date of Death Age If Veteran of U.S. Armed Forces,
`'
;fir May 2,2015 87 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death I XI Natural Cause 0 Accident DHomicide 0 Suicide n Undetermined n Pending
Circumstances Investigation
Medi al Certifier' Na ` Title
I
�CCGd1� \ rn\\
Address 1
,,, Death Certificate Filed ` ) District Number Regist ber
City, Town or Village Glens Falls,NY 5601
0 Burial Date Cemetery or Crematory
May 6, 2015 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
H Hold
V)
Q Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
%l Permit Issued to Registration Number
6 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
Permission is hereby granted to dispose of the human remains descri ed a ove s i ' ted.
Date Issued S�s�`a0�.5" Registrar of Vital Statistics
JG �I,r/ c
signature)
``r District Number 5601 Place Glens Falls,NY /c2S/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LuDate of Disposition 5/6/201 5 Place of Disposition p; nP Vi pw CAm' to( d,y s)eensbury, NY
W
N Erie 20A
W (section) (lot number) (grave number)
QName of Se on or Person in Charge of Pre • Connie L. Goedert
`Z (please print)
Signature / ��. LPL Title Cemetery Superintendent
(over)
DOH-1555(02/2004)