Bradway, Cynthia '# 57
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
'`` Name First Middle Last Sex
Cynthia Ann Bradway Female
Date of Death Age If Veteran of U.S. Armed Forces,
' January 28,2015 61 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls, NY Street Address 168 Ridge Street
Manner of Death I xir—I Natural Cause n Accident Homicide n Suicide Undetermined 1-1 Pending
Circumstances Investigation
Medical Certifier Name Title
yj Paul Bachman,Coroner
Address
gf Warrensburg,NY
f to Death Certificate Filed District Number Register Number
C• ity, Town or Village Glens Falls,NY 5601 ,5 0
❑Burial Date Cemetery or Crematory
❑Entombment January 30,2015 Pine View Crematorium
Address
L1 Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
H Hold
N
o Date Point of
Nn Transportation Shipment
'p by Common Destination
Carrier
n Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
P• ermit Issued to Registration Number
l Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
'=- Address
407 Bay Road, Queensbury, NY 12804
e Name of Funeral Firm Making Disposition or to Whom
R• emains are Shipped, If Other than Above
-- Address
Permission is hereby granted to dispose of the human remains described above as indicated.
�`�� Date Issued i(2Q/ 1.5 Registrar of Vital Statistics
a (signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition i/30(Is Place of Disposition 'EL., C. tp —
2 (address)
W
Cr (section) //p�of numbej) (grave number)
pName of Sexton or Person in Charge of Premises tivii do*
Z (pie print),
LU Signature I Title 11trb"104.
(over)
DOH-1555(02/2004)