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Swinton, Mary NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit T Name First Middle Last Sex Ma K Swinton Female Date of Death Age If Veteran of U.S.Armed Forces, 11/11/2017 87 Years War or Dates j Place of Death Hospital, Institution or - = City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitati Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Gwendolyn Morris-Dickinson PA Address 170 Warren St,Glens Falls,New York 12801 `.:".- tft, Death Certificate Filed District Number Register Number x City, Town or Village Glens Falls 5601 580 ❑Burial Date Cemetery or Crematory 11/15/2017 Pine View Crematory Aw❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment 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 g 407 Bay Rd,Queensbury,New York 12804 k 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. fig Date Issued 11/13/2017 Registrar of Vital Statistics R96ert.xCurtis 5IkcroniaaltySwned (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition III Z3i Place of Disposition ,C r- �w (address) r ©t 4 . (section) 4 (lot number) c, (grave number) Name of Sexton or Person in Charge of Pre 'ses ArATIL,,r' /fit y (pe print) ems; Signature Title (tzfinrTgl'l (over) DOH-1555 (02/2004)