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Hoffay, Janet NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit F„c. Name First Middle Last Sex ▪ , Janet Elizabeth Hoffay Female . f Date of Death Age If Veteran of U.S. Armed Forces, rr June 13,2015 87 War or Dates r Place of Death Hospital, Institution or City, Town or Village Queensbury, NY Manner of Death Street Address Westmount Health Facility uikNatural Cause n Accident Homicide Suicide Undetermined 1 1 Pending Circumstances Investigation �f Medical Certifier Name Title Roslyn Socolof,MD Address rFr Queensbury,NY Death Certificate Filed District Number R©sNumber ' City, Town or Village Queensbury,NY 5657 ❑Burial Date Cemetery or Crematory ❑Entombment June 16, 2015 Pine View Crematorium Address ®Cremation 21 Quaker Road,Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold CO O Date Point of NTransportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Renterment Date Cemetery Address Permit Issued to Registration Number 01 Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address '.r 407 Bay Road, Queensbury, NY 12804 11 Name of Funeral Firm Making Disposition or to Whom `' Remains are Shipped, If Other than Above . Address :4f Permission is hereby ranted to dispose of the huma remains describ above as indicated. _ '< Date Issued Ls2i. ) S t c: Utiegistrar of Vital Statistics C .......P; �; (signature) —_,....----- 44 District Number �(..aj r) Place 1 U ,,,__.r .„ C7 � I certify that the remains of the decedent identified above were disposed of in accorda ce th this permit on: Z w Date of Disposition C/(1 I'S—Place of Disposition -41) ,,, esi-e,•••/W (address) CO W (section) (lot nu r) (grave number) pName of Sexton or Person in Charge of Premisesir Z (please pent) W Signature /�"� Title 474544'11(1'� (over) DOH-1555(02/2004)