Williams, Eleanor I f .
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Eleanor Jane Williams Female
}}; Date of Death Age If Veteran of U.S. Armed Forces,
;;; ; August 14, 2015 88 War or Dates
I Place of Death Hospital, Institution or
City, Town or Village Glens Falls
Manner of Death
Street Address Glens Falls Hospital
X Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Sean Bain
ro Address
100 Park St,Glens Falls,NY 12801
:{= Death Certificate Filed District Number Re t�r Number)
fir.' I�
x".:. City, Town or Village Glens Falls, NY 5601
❑X Burial Date Cemetery or Crematory
August 18, 2015 West Glens Falls Cemetery
❑Entombment Address
❑Cremation Corinth Rd, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
2 and/or Address
F' Hold
N
0 Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
'. i Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
rrr Name of Funeral Firm Making Disposition or to Whom
1Remains are Shipped, If Other than Above
Address
:;:: Permission is hereby granted to dispose of the human r mains d:,-cribed bove as indi :ted.
:i::,; Date Issued Registrar of Vital Statistics , i 1e� 4 �' .,
(signatu e)
>' District Number S6,0/ Place Glens Falls,NY
I certify that the remains of the decedent identified above were . sposed of in accordance with this permit on:
tDate of Disposition 8/1 8/1 5 Place of Disposition west Glens Fallsaddres Cemetery, Qii nshury
W / /ill ka-(, /
c (section) (lot number) (grave number)
QName of 't n or Person in Charge of Premises Connie L. Goedert
Z (please print)
W �p
Signatur Alm. U�,. teGta Title Cemetery Superintendent
(over)
DOH-1555(02/2004)