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Whiting, Mary Ann
NEW YORK STATE DEPARTMENT OF HEALTH - - Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary Ann Whiting Female Date of Death Age If Veteran of U.S.Armed Forces, 02/07/2020 91 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W 'p Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending V Circumstances Investigation W Medical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Vi Uage Glens Falls 5601 65 Burial Date Cemetery,Crematory or Facility Name 02/10/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held N Hold Address O 0. W Transportation Date Point of jS 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 I.. Remains are Shipped,If Other than Above Address W I' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2020 Registrarof Vita[Statistics &6ertArafrew Curtis(ECectronicaCCySiynet) (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: J Date of Disposition 2 i1 )Zo Place of Disposition � / {� tu (address) W (sectian/ / (lot num r/ (grave number) O Name of Sexton or Person in Cha of Premi ses v '�t t) Z se print/ W Signature Title �Q DOH-1555(o7/t8)p 1 of 2 Public Health Law Sec. 4145(2b) 013330 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#