Howard, Helen 3 21—\r)---
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Helen Marie Howard Female
-.. Date of Death Age If Veteran of U.S. Armed Forces,
April 20, 2012 70 War or Dates
>` Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 8 Margaret Drive
t1
: Manner of Death [Aim' Natural Cause n Accident ❑Homicide U Suicide ❑Undetermined Pending
Circumstances Investigation
r Medical Certifier Name .-- Title
Address
'. Death Certificate Filed District Number Re ter Number
il City, Town or Village Queensbury,NY 5657 c---
❑Burial Date Cemetery or Crematory
April 24, 2012 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ 1ri 1 Removal and/or Held
and/or Address
H Hold
N
O Date Point of
N ❑Transportation Shipment
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
n Permit Issued to Registration Number
=<� Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
%f
Address
407 Bay Road, Queensbury, NY 12804
i; Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
w Address
Permission is hereby granted to dispose of the human emains described abo eka indicated.
0
'Ye, Date Issued 7 o�)�,Registrar of Vital Statistics
(signature))
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z p t Place of Disposition ,,,,, �w»cf rw..,
� Date of Disposition 40r/it '
P I �u
(address)
W
Cl)
Ce (section) (lot nurpber) (grave number)
QName of Sexton or Person in Charge of remises ��r►� - t,,11—
Z 41 (please print)
W loft__ Title CL&44wA-iU(L
(over)
DOH-1555(02/2004)