Winans, Lorraine M. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lorraine M.Winans Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/14/2019 92 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address 23 Jay Street 3G,Glens Falls,New York 12801
WManner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
V Circumstances Investigation
Medical Certifier Name Title
Gerard Abess MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 489
Burial Date Cemetery,Crematory or Facility Name
11/18/2019 Pine View Crematory
Entombment Address
ECremation Queensbury Town,New York
Donation
OZRemoval Date Place Removed
and/or and/or Held
H Hold Address
O
a Date FSPch
int of
N ❑Transportation ipment
p by Common
Carrier Destination
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 Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
iW
Q' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/15/2019 Registrar of Vital Statistics WoAen,3ndrew Carta(—Electronicaly(Srgned)
(signature/
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H '
Z Date of Disposition 11 181 Iq Place of Disposition
W (address)
2
W
N (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises
/ (pl se print)
W Signature �i/, �_ Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 13 0
Receipt
Human remains of delivered on , 20_
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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