Howe, Audrey NEW YORK STATE DEPARTMENT OF HEALTH P- t- ' J
Vital Records Section Burial - Transitit,1
rmit
Name First Middle Last Sex
i. Audrey W.rf., Howe Female
V' Date of Death Age If Veteran of U.S. Armed Forces,
,f.t
February 26, 2016 85 War or Dates n/a
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address 325 Broadway, Apartment 32
Manner of Death n Natural Cause 0 Accident El Homicide n Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Paul Filion,MD
' Address
.'.,-',..0 2 Irongate Plaza,Glens Falls,NY 12801
r . Death Certificate Filed District Number 5755 Register,lyumber
City, Town or Village �v�
❑Burial Date Cemetery or Crematory
February 29, 2016 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
111
Disinterment Date Cemetery Address
n 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
. Remains are Shipped, If Other than Above
Address
•
Permission is hereby granted to dispose of the hu n s describ d b ve s indicated.
&' Date Issued 62 016;Registrar of Vital Statistics
% ;; _ (signature)
District Number 6765 Place l 6-1,i6-6L &C1GW A 4
,,,„
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3/Z//t, Place of Disposition 21...1 eriely MN)
2 (address
IL
co
tY (section) a (lot number) (grave number)
Q Name of Sexton or Person in Charge o Premises ff -t i
W / (pl ase print)
Signature a Title
(over)
DOH-1555(02/2004)