Reardon, Judith ._ - a- +
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Judith Mary Reardon Female
Date of Death Age If Veteran of.U.S. Armed Forces,
7/19/2018 75 War or Dates
Place of Death Hospital, Institution or
, City, Town or Village Glens Falls Street Address 20 First Street
Manner of Death a Natural Cause C Accident El Homicide 0 Suicide Undetermined I I Pending
Circumstances Investigation
Medical Certifier Name Title
to Mary Stein,MD
Address
Queensbury,NY
Death Certificate Filed District Number Register Number .353
City, Town or Village Glens Falls,NY 5601
❑Burial Date Cemetery or Crematory
❑Entombment July 23,2018 Pine View Crematorium
Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
ZO 1-7 Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
Nn Transportation Shipment
0 by Common Destination
Carrier
n Disinterment Date Cemetery Address
Renterment 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
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains desc ed abov s i i ed.
r
W. Date Issued 07/23/2Die Registrar of Vital Statistics
�: (signature)
District Number c5-6O/ Place o% . .//, Aiy
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 7— JJ-1� Place of Disposition (�;, �, V c,fG',edory
( (address)
W
co
re (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises re('rtie y Yuvir',S
ILI
.Z v (please print)
Signature / �- Title GkAtenb .
odor, . -
(over)
DOH-1555(02/2004)