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Chenier, Ida NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit , '`v: Name First Middle Last Sex 00 Ida Marie Chenier Female /11 Date of Death Age If Veteran of U.S. Armed Forces, r October 28,2016 91 War or Dates '% Place of Death Hospital, Institution or City, Town or Village Saratoga Springs Street Address Saratoga Hospital . Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certi i rol6 Nape n/k o I Title it Addres �/'� .„;i. Death Certificate Filed , District Number Register Number ipS City, Town or Village Saratoga Springs \-1 45U4-- i-.l J bl ,' ©Burial Date Cemetery or Crematory November 3, 2016 St. Alphonsus Cemetery ❑Entombment Address ❑Cremation Pine Street, Queensbury,NY 12804 Date Place Removed Z n Removal and/or Held O: and/or Address H Hold co 0 Date Point of N 1 i Transportation Shipment Q by Common Destination Carrier Disinterment Date Cemetery Address pi Reinterment Date Cemetery Address • Registration Number Permit Issued to 01596 g Name of Funeral Home Singleton Sullivan Potter Funeral Home pAddress 407 Bay Road, Queensbury,NY 12804 '? Name of Funeral Firm MakingDisposition or to Whom �r�, P Remains are Shipped, If Other than Above Address , .•: Permission is j1j7.DLIRegistrarofVitalStatlstics remaind`esco dicatedDate Issued (signature) ' = District Number .4591 q 0,I Place Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with t s permit on: W Date of Disposition II It 4 Place of Disposition VT. din g -A-4 1/dr ) 6. CD CL (section) i(lot tuber (grave number) Name of Sexton or P rsbn in Charge of Premises w- Z (please print) W Title Signature (over) DOH-1555(02/2004)