Carr, Beatrice4613
N EW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
Burial - Transit Permit
Name First Middle Last
Sex
Beatrice Lois Hess Carr
Female
Date of Death
Age
If Veteran of U.S. Armed Forces,
09/15/2019
100 Years
War or Dates
Place of Death
Hospital, Institution or
WCity,
Town or Village Queensbury Town
Street Address 28 Carr Lane, Queensbury Town, New York 12845
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Mannerof Death 91 Natural Cause Accident Homicide Suicide El Undetermined Pending
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Circumstances Investigation
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Medical Certifier Name Title
Anthony Petracca MD
Address
3 Irongate Center, Glens Falls, New York 12801
Death Certificate Filed
District Number
Register Number
City, Town or Village Queensbury
5657
136
Burial
Date Cemetery, Crematory or Facility Name
Entombment
09/16/2019 Pine View Crematory
Address
RICremation
Queensbury, New York
Donation
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Removal
Date
Place Removed
and/or Held
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and/or
Hold
Address
QN
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� Transportation
Date
Point of
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Shipment
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
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Remains are Shipped, If Other than Above
%
Address
It
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a
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/16/2019 Registrar of Vital Statistics Carol&exldegarde Bader(Electronaca/ySigned�
(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:
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Date of Disposition q III III Place of Disposition
(address)
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Q(section)
(lot number/S (grave number)
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Name of Sexton or Person in Charge of Premises �'t""��
(pi se print)
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Signature [„/ /[.�,t. Title )w"Y
DOH-1555 (07118) p 1 of 2
Public Health Law Sec. 4145(2b)
612539
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home nanp4d on buri permit
Official Funeral Directors Reg. or Licensee