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Cady, Betty NEW YORK STATE DEPARTMENT OF HEALTH = .4\ # t Vital Records Section Burial - Transit Permit Name First Middle Last Sex C' Betty J Cady Female ' Date of Death Age If Veteran of U.S.Armed Forces, 12/29/2018 86 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© ❑Undetermined ❑Pending ,-&. Natural Cause Accident Homicide Suicide 9 Circumstances Investigation r. Medical Certifier Name Title `'"x Roslyn Socolof MD C.4 Address -4 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number p City, Town or Village Fort Edward 5755 79 ❑Burial Date Cemetery or Crematory 01/02/2019 Pine View Crematory ❑Entombment Address to, Queensbury, New York tTrit Date Place Removed " '❑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 • :q Permit Issued to Registration Number ? Name of Funeral Home Singletor divan Potter Funeral Home 01596 • Address 407 Bay Rd,Queensbury,New York 1e i4 Name of Funeral Firm Making [ sposition or to Whom ,' Remains are Shipped, If Other gran Above Address x„t i Permission is hereby granted to dispose of the human remains described above as indicated. li• Date Issued 01/02/2019 Registrar of Vital Statistics Aimee Mahoney(ECectronicaltySigned)1 (signature) 4:1 A. District Number Place 5755 Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 4,4 'II j Date of Disposition I li I II Place of Disposition 4�.�,,.. 4....-t o r/ , , (address) i a (section) (l umber) (grave number) el Name of Sexton or Person in Charge of Premises I A(+ r)poilIt ��� (please p nt) -, Signature G.{ Title trellYi%it (over) DOH-1555 (02/2004)