Bishop, Catherine NEW YORX'STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
,
F f. Name First Middle Last Sex
Catherine A. Bishop Female
k'r' Date of Death Age If Veteran of U.S. Armed Forces,
June 27, 2012 85 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death12L Natural Cause Accident Homicide Suicide ❑Undetermined n Pending
Circumstances Investigation
Medical Certifier Nam Title
r I. Qr& Jr. I-ID
fir;
f<. Death Certificate Filed District Number Register Number
FfF City, Town or Village Fort Edward,NY (.S 3) --
❑x Burial Date Cemetery or Crematory
July 3, 2012 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
W ❑Transportation Shipment
p' by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
'`` Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
„,,,j 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 anted to dispose of the human r mai .describ ve as indi ated.
Date Issued i gistrar of Vital Stati ics .44_
(signature)
District Number / Place Fort Edward,NY
I certify that the remainsin J o��f the decedent identified above were disposed of in accordance with this permit on:
Z
111 Date of Disposition 7/3/1 2 Place of Disposition Pine View Cemetery
W (address)
Hudson Sec. 3 23 B & 24 C 5
ce (section) (lot number) (grave number)
QName of Sexton or Person i Charge of Premises Michael Genier
uZ - (please print)
Signature Title Superintendent
(over)
DOH-1555(02/2004)