French, kay Alys . loos
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kay Alys French Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/09/2020 81 Years War or Dates
ZPlace of Death
Hospital.Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death 0 Natural Cause 0 Accident ❑Homicide ❑Suicide ❑Undetermined 0 Pending
V Circumstances Investigation
WG Medical Certifier Name Title
Marcille Labban MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 462
Burial Date Cemetery,Crematory or Facility Name
10/13/2020 Pine View Crematory
11 Entombment Address
0 Cremation Queensbury,New York
0 Donation
Qn Removal Date Place Removed
and/or and/or Held
t- Hold Address
N
0
a Date Point of
❑
Cl)
Transportation
0by Common Shipment
Carrier Destination
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 Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
a Address
MC
lW
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/13/2020 Registrar of Vital Statistics .�o6ert.,YnurewCurtir(E/ctronicaf SOtred)
(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: ak".........Date of Disposition f0//S 170 Place of Disposition
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III2 (address)
W
CD
MC (section) (lot number) (grave number)
Name of Sexton or Person in Ch a of Premises +1 It
g g All �
Z (pleat print
W Signature � Title r°1WITVit
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) ° ..4 0
Receipt
Human remains of delivered on , 20
I PineView Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#