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Yanker, Barbara (2)
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit =, Name First Middle Last Sex Marie A Guida Female „_ Date of Death Age If Veteran of U.S. Armed Forces, '- August 23, 2012 90 War or Dates IPlace of Death Hospital, Institution or City, Town or Village Glens Falls,NY Street Address The Pines Of Glens Falls i Manner of Death n Natural Cause Accident n Homicide Suicide Undetermined Pending lit Circumstances Investigation M Medical Certif Iti Name t . D Title ( .s..,` RT ..._ , ri addreseirs\ s \aP Death Certificate Filed \ U District Number Register r City, Town or Village Glens Falls,NY 5601 ©Burial Date Cemetery or Crematory August 27, 2012 Pine View Cemetery ❑Entombment Address ❑Cremation Quaker Road, Queensbury, ,NY 12804 Date Place Removed Z Removal and/or Held • and/or Address H Hold N O Date Point of u) Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address Date Cemetery Address (-Reinterment aa, 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 E. Address le, kii . Permission is hereby granted to dispose of the human emains escribe above as ' dicat-d. (J e Date Issued Registrar of Vital Statistics K f,-) � A,.o (signature) - District Number 5601 Place Glens Falls,NY / I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 8/27/1 2 Place of Disposition Pine View Cemetery 2 (address) W N Horicon 1B 2 (section) (lot number) (grave number) p• Name of Sexton or Person in Charge of Premises Michael Genier Z (please print) W Signature 21)tivwfd— Title Superintendent (over) DOH-1555(02/2004)