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Root, Linda Ann
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Linda Ann Root Female Date of Death Age If Veteran of U.S.Armed Forces, O2/06/2O2O 77 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death � Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 67 ©Burial Date Cemetery,Crematory or Facility Name 02/14/2020 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York ❑Donation z Removal Date Place Removed and/or and/or Held H N Hold Address O d Date Point of N ❑Transportation p by Common Shipment 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 F.. Remains are Shipped,If Other than Above Address W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2020 Registrar of Vital Statistics -1'Q6err, rrewCurtu(EYectro-wallySVneC� (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 9 J 1: (Place of Disposition NY 12804 W 2 (address/ W Hohican 67B 2 N � (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises Con i 2 GOedert Z /please print/ W Signature L -A Tit DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) -. 010366 Receipt Human remains of delivered on , 20_ Pine View Cemetery ✓ Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#