Garcia, Carol NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
Name First Middle Last Sex
f.
Carol Hall Garcia Female
i Date of Death Age If Veteran of U.S. Armed Forces,
09/23/2016 79 War or Dates n/a _
`,': Place of Death Hospital, Institution or
• City, Town or Village Glens Falls Street Address 43 Ridge Street
Manner of Death n Natural Cause 1 1 Accident r Homicide Suicide 1-1 Undetermined n Pending
Circumstances Investigation
:: Medical Certifier Name Title
ff� Anthon Petracca MD
,). Address
00 3 Irongate Center,Glens Falls,NY 12801
Death Certificate Filed District Number Regais� +er
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory ++++
9/2 6/2 01 6 Pine View Crematory
Entombment Address
Ii Cremation Quaker Road, Queensbury, NY
z Date Place Removed
0ElRemoval and/or Held
p and/or Address
N Hold
d � Date Point of
N Transportation Shipment
0 by Common Destination
Carrier
[i Disinterment Date Cemetery Address
I Reinterment Date Cemetery Address
'.. Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
T/ 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 human remains described above as indicated.
:. .
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; ; Date Issued Registrar of Vital Statistics
eve
(signature)
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District Number 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 1 /zctl(b Place of Disposition Zoo...) (*motor ..v ,
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(section) g 7 (lot number) (grave number)
p0 Name of Sexton or Person in Charge of Premises (II S fl,1b/
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W Signature C�,t Title 67,1.%07140n,_.
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