Brennan, Joyce NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Al Name First Middle Last Sex
Joyce Marilyn Brennan Female
Date of Death Age If Veteran of U.S. Armed Forces,
» February 16,2018 82 War or Dates n/a
i4
Place of Death Hospital, Institution or
City, Town or Village Glens Falls,NY Street Address Glens Falls Hospital
Manner of DeathLiL.IR71Natural Cause E Accident IIIHomicide n Suicide ❑Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
Christopher Hoy,MD
Address
Queensbury,NY
Death Certificate Filed District Number Register ummer
w City, Town or Village Glens Falls,NY 5601 //
❑Burial Date Cemetery or Crematory
❑Entombmerrt February 20,2018 Pine View Crematory
Address
®Cremation Queensbury,NY
Date Place Removed
Z U Removal and/or Held
and/or Address
H Hold
N
O Date Point of
5 ❑Transportation Shipment
p by Common Destination
Carrier
Ell
Disinterment Date Cemetery Address
f Reinterment Date Cemetery Address
Permit Issued to Registration Number
A Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
A Address
q4, 407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
g Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remain es rib ab s indicated.
flm
Date Issued Pg 3aA30A' Registrar of Vital StatisticsTin
/G ✓
(signature)
District Number 5601 Place City of Glens Falls,NY
iirili
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ui Date of Disposition Zjz3IIR Place of Disposition f,.„,ti,,, 4,10, —..
W (address)
N
re (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premi es to .S4„lt'
`Z2 (pl ase print)
Signature Title //ti/ y 7 L.
(over)
DOH-1555(02/2004)