Stewart, Claire NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Claire L. Stewart Female
Date of Death Age If Veteran of U.S. Armed Forces,
I-s PRIMea�1�,h 82 Years War or Dates
Hospital, Institution Not or ApPlicabl®
; Town or . Street Address
��� �er of D �� ! ' nation
Natural Cause Accident ❑Homicide El Suicide n ILI
tu Medical Certifier Name Title
ABtre/Oddy RN NP
2050 Tilden Avenue, New Hartford, NY 13413
01 Death Certificate Filed District Number Register Number
- .�►� Town or
Burial New HertfordCem�ee ry or Crematory 271
' > ■Entombment Address 112014 St Aipbonsus Cemetery
OCremation
-Date New Yogic Place Removed
g.El❑Removal and/or Held
ouii and/or Address
M=" Hold
0 Date Point of
9.i El Transportation Shipment
0 by Common Destination
igiii Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
I> Permit Issued to Registration Number
>! Name of Funeral Home Singleitnnheskly Funeral Home, Inc 01596
Address
mi 4Q7 Bay Road,Queensbury Ny_ 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
IX
UI
Permission is hereby granted to dispose of the human remains described above indicated.
Date Issued 04/28J7014 Registrar of Vital Statistics . CA
��� 'y62
7efure) "("1":47
District Number Place
��J
3264 New Hartford
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition 51 I I I`t Place of Disposition LA e 4 r er Q. a.-11 4 S )2 v•I/ 4/.44"
s " !!! (address)
111
to A () 2 ) 5
III (secti n) ' ' ! (lot number) (grave number)
Name of Sexton or Person in Charge of Premises � ^ I s t•i
Z (please print)
la
Signature Title 014'14 J
(over)
DOH-1555 (02/2004)