Weill, Joan NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joan S. Weill Female
r?{ Date of Death Age If Veteran of U.S. Armed Forces,
February 14, 2015 78 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
iii Manner of Death g Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
;; John P. Stoutenburg,MD
Address
102 Park St. Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village GLens Falls 5601 iO
❑Burial Date Cemetery or Crematory
February 16, 2015 Pine View Crematorium
El Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
2 and/or Address
H Hold
Cl)
0 Date Point of
coTransportation 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
::E:i 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 g dispose to dis ose of the huma remains scribe Bove as i dicate..
Date Issued 04/ �U/S Registrar of Vital Statistics 7 ,Q��, 73 & t<
(signature)
District Number 5601 Place GLens Falls
I certify that the remains of the decedent identified above we disposed of in accordance with this permit on:
Z
W Date of Disposition Z IIg I Is Place of Disposition Z0-4 C 1 ,.,
W (address)
co
re (section) goo .(lotnumber) (grave number)
pName of Sexton or Person in Charge of Premises 3 Qn!' '
'Z (please print)
Signature ,., Title aZ/tarleriTX
?L."'
(over)
DOH-1555(02/2004)