Morris, Yolanda NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Yolanda C Morris 1 Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 5, 2012 86 War or Dates No
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Eti Manner of Death X Natural Cause Accident 1 1 Homicide Suicide Undetermined Pending
tti
0Circumstances Investigation
us Medical Certifier Name Title
Ff] Nancy Carney
Address
::',Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 53 2
❑X Burial Date Cemetery or Crematory
❑Entombment December 10, 2012 St.Alphonsus Cemetery
Address
❑Cremation , Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
E Hold
N
O Date Point of
Ph ( 1 Transportation Shipment
p by Common Destination
Carrier
El
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
:i Name of Funeral Firm Making Disposition or to Whom
iv+? Remains are Shipped, If Other than Above
gAddress
liS
Permission is hereby granted to dispose of the human remains described above ats indicated.
Date Issued )2-1 5 1 E Z Registrar of Vital Statistics W W
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition J Z`i c I I Place of Disposition Sf- eh e:S�'S (vhetcr`f a e p.,s kJ y NI)
(addres§) t
C Lo(- S
CC
(s t� _\.. lot umber) (grave number)
o• Name of Sexton or Person in Charge of Premises G` .,. . i
Z (p ease print)
W Signature ( (0----
�� Title ACV C q/
(over)
DOH-1555(02/2004)