Manaher, Florence 7vt,
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Florence A. Manaher Female
Date of Death Age If Veteran of U.S. Armed Forces,
February 11, 2016 93 War or Dates n/a
1... Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address 1260 West Mountain Road
.0 Manner of Death n Natural Cause Accident Homicide Suicide pi Undetermined Pending
fiL Circumstances Investigation
w Medical Certifier Name Title
O Christopher Hoy,MD
Address
Queensbury,NY
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury, NY 5657 ��
II Burial Date Cemetery or Crematory
February 16, 2016 Pine View Cemetery
IIIEntombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z ❑Removal and/or Held
O
and/or Address
H Hold
N
O —
Date Point of
N _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
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
1-. Remains are Shipped, If Other than Above
$' Address
CL
▪ Permission is hereby granted to dispose of the human remains described ab va as indicated.
Date Issued Q.j (a2egistrar of Vital Statistics , T_ `-=-tom
(signature)
District Number PlacC.
e �-� �
I certify that the remains of the decedent identified above were disposed of in accor4ance with this permit on:
Z
Ili Date of Disposition 2/1 6/1 6 Place of Disposition Pine View Cemetery, Queensbury, NY
W (address)
v) Mohican 42C 3
O (section) (lot number) (grave number)
Q Name of Se n or Person in Charge of Premises Connie L. Goedert
Z (please print)
w
Signature , Title Cemetery Superintendent
. � �
(over)
DOH-1555(02/2004)