Varney, Gail 73
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
li Name First Middle Last Sex
Gail Joyce(Aust) Varney Female
a Date of Death Age If Veteran of U.S. Armed Forces,
,; 9/20/2018 84 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 34 Garfield Street
Manner of Death ❑X Natural Cause ❑Accident ❑Homicide E Suicide ❑Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
Paul Filion,MD
Address
', G• lens Falls,NY
D• eath Certificate Filed District Number Register u bar/
City, Town or Village Glens Falls,NY 5601 �`
❑Burial Date Cemetery or Crematory /
❑ September 25,2018 Pine View Crematorium
Entombment Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z ri❑Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
El 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 Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
Address
Permission is her y granted to dispose of the human emains escrib d above a, indica =d.
ti-
Date Issued ��'� Registrar of ital S istics 1%
/ ���(signature)
'N District Number .�66 / Place /�����-�-�7
f
H I certify that the remains of the decedent identified above w e disposed of in accordance w' this permit on:
w Date
of Disposition 9 J a lig Place of Disposition flit V„r `,M.y f do,t.e.
(address)
Cl)1111
O (section) (lot number) ( (grave number)
pName of Sexton or Person in Charge of Premises `fir.rkylu,.-r)giAtti-
Z (plea print)
W Signature ir Title (IG£rylf ilie,
(over)
DOH-1555(02/2004)