Steves, Carole t
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
it
Name First Middle Last Sex
Carole Annette Steves Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/20/2018 81 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
Manner of Death j Natural Cause n Accident D Homicide D Suicide El Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Philip Gara MD
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edward 5755 36
❑Burial Date Cemetery or Crematory
07/30/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
ri Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
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 07/23/2018 Registrar of Vital Statistics Aimee A2ahoney Octronica1tySigned)
(signature)
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1131 lig Place of Disposition � 1L 4 --'
(address)
(section) pilot number) (grave number)
Name of Sexton or Person in Charge of Premises 4 Ar ie74tit
(Ple print)
Signature Title () ,
(over)
DOH-1555(02/2004)