Caprara, Sandra NEW YORK STATE DEPARTMENT OF HEALTH f 637
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
:r. Sandra Rose Caprara Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 20, 2015 59 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
li Manner of Death X Natural Cause Accident n Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
gi Howard E. Silverberg
Address
48 East Street,Fort Edward,NY 12828
Death Certificate Filed District Number % Register Num F7
i
Cty, Town or Village
.. ❑Burial Date Cemetery or Crematory
Ill Entombment July 22, 2015 Pine View Cemetery
Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
0 Date Point of
O.
Transportation Shipment
a 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
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 ranted to dispose of the human rer.ains described above as in .
Date Issued 0 Registrar of Vital Statistics — 7�,�
t(si nat re)
District Number -.O/ Place 1 >j9,'
I certify that the remains of the decedent identified above were disposed of in accorda)
with this permit on:
Z �. .. (
W Date of Disposition 7�L3�f5- Place of Disposition , -
2 (address)
W
U)
CC (section) //pot number) (grave number)
Q `Name of Sexton or Person in Charge of Premises u,. ..' %.441-
Z (ple se print)
W
Signature ;-- Title Pl f r
(over)
DOH-1555(02/2004)