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Ward, Bernice K.
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Bernice K Ward I Female Date of Death Age If Veteran of U.S.Armed Forces, 01/23/2020 75 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death © Natural Cause Accident Homicide F1 Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Vill a Glens Falls 1 5601 43 Burial Date Cemetery,Crematory or Facility Name 01/25/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation ZR Removal Date Place Removed Fand/or and/or Held Hold Address IL Date Point of N Transportation Shipment j5 by Common Carrier Destination Disinterment Date Cemetery Address Einterment Date Cemetery Address Registration Number Permit Issued to 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 W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/24/2020 Registrar of Vital Statistics 9?gbertAndrew Curtis(EfectronicaCCySiyned) (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 W Date of Disposition Is P, �/e-d 020 Place of Disposition i t r Uj (aaar ss/ W N (section) (lot number) (grave number/ Name of Sexton or Person in Cha of Premise ) �"�� o� (p/ease print) W Signature Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) J 1 3 271 Receipt Human remains of delivered on , 20_ i jPine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# I i