Parsons, Gisele T. �rs1I
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gisele T.Parsons Female
Date of Death Age If Veteran of US.Armed Forces,
05/10/2020 95 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Queensbury Town Street Address 10 Bayberry Drive,Queensbury Town, New York 12804
ul Mannerof Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Danushan Sooriabalan MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 101
❑Burial Date Cemetery,Crematory or Facility Name
05/12/2020 Pine View Crematory
Entombment Address
cl Cremation Queensbury,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
Hold Address
Transportation
Date Point of
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
Remains are Shipped,If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/12/2020 Registrar of Vital Statistics CaroCrnexfdegarde 0a4er(Electronicady Signed/
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 61 l> 70 Place of Disposition ✓ n�
(address/
L�
(section/ ( (lot number) (grave number)
Name of Sexton or Person in Charge of Premi ►`t'`I
(ple a print)
W' Signature Title
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 0 `" 3 78 6
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on.burial permit
Official Funeral Directors Reg.or License#