Harrison, Joyce . . I
NEW YORK STATE DEPARTMENT OF HEALTH It 3a5
Vital Records Section Burial - Transit Permit
"' Name First Middle Last Sex
Joyce D. Harrison Female
is Date of Death Age If Veteran of U.S. Armed Forces,
^ April 26,2017 87 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death u_kiNatural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined n Pending
Circumstances Investigation
- Medical Certifier Name Title
Robert Love MD
Address
.; 3 Irongate Center,Glens Falls,NY 12801
%'` Death Certificate Filed District Number RegistcN mjer
fi'f••
s•r,
City, Town or Village Glens Falls 5601
f.
❑Burial Date Cemetery or Crematory
April 27, 2017 Pine View Crematorium
❑Entombment Address
Al Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
❑Removal and/or Held
112 and/or Address
Hold
00
Date Point of
Transportation Shipment
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
'ry Permit Issued to Registration Number
F 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 Ship
ped, If Other than Above
Address
: Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Li f 2-"1 )1 7 Registrar of Vital Statistics L".9 c ' -A-1`411‘44—
.:.
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 5 (1 )f'7 Place of Disposition ��tV,,i.,� / ^�� er`�
(address)
(section) , (lot number) (grave number)
Z Name of Sexton or Person in Charge of Premises /ors L.. _3 riA/N
(plese print)
LU
Signature Title ( fI 1a
(over)
DOH-1555(02/2004)