Glandon, Victoria I" t` #i3`8
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
1 E Name First Middle Last Sex
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Victoria Grant Glandon Female
' Date of Death Age If Veteran of U.S. Armed Forces,
{r': August 3,2015 64 War or Dates
i:::: Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 63 Knox Road
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
John Sawyer DR.
,{r1 Address
'%:* 14 Manor Drive,Queensbury,NY 12804
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r:r Death Certificate Filed Digrict Number Re aster Number
ti�:; City, Town or Village (9 C 1 'j
❑Burial Date Cemetery or Crematory
August 4, 2015 Pine View Cemetery
❑Entombment Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F' Hold
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0 Date Point of
NI I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
: f Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
:: Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
t Permission is hereby granted to dispose of the human remains described above as indicated.
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Date Issued�j�� k�/C� Registrar of Vital Statistics
}, (signature)
District Number Sac C) Place )U,,,-M a-I' I , ,)
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I certify that the remains of the decedent identified above were disposed of in ccordanc with this permit on:
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w Date of Disposition QJi,j Jr Place of Disposition ;„4 Ci4 4t'J,i...,
(address)
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Ce (section) //jj (lot numb ) (grave number)
QName of Sexton or Person in Charge of Premises (it rri4 t AA Sit
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Signature d Title WPM
(over)
DOH-1555(02/2004)