Fleming, Deborah - -2ig
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Deborah Fleming Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 16, 2017 61 War or Dates
1N Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address Stanton Nursing & Rehab Centre
▪ Manner of Death in Natural Cause n Accident _Homicide Suicide n Undetermined n Pending
uj
Circumstances Investigation
w Medical Certifier Name Title
CI Roslyn Socolof
Address
Stanton NH, 152 Sherman Ave,Glens Falls,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657
❑Burial Date Cemetery or Crematory
March 17, 2017 Pine View Crematorium
❑Entombment Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
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0 Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment 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
I— Remains are Shipped, If Other than Above
2 Address
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4 Permission is hereby granted to dispose of the human e ains described bove as indicated.
Date Issued,�l ( i I 1 Registrar of Vital Statistics %---t
�c _j f (signature)
District Number' J,"—� Place t j c ( C l 1 S1.-Q-7-.5��
I certify that the remains of the decedent identified above were disposed of i accorda e with this permit on:
W Date of Disposition yzop 7 Place of Disposition Pill e V i Gl'-rnc1 kr,2 (addresef
W
U)
CL (section) (lot nuj�ber) (grave number)
QName of Sexton or , r on ' Charge of Premises -1 f i<<s✓, C,4rn e.
Z ' (please print)
w Signature Title � o__Ynw-/D
(over)
DOH-1555(02/2004)