Greeno, Janet NEW YORK STATE DEPARTMENT OF HEALTH �0 I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Janet Charlene Greeno Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 20, 2012 49 War or Dates
• Place of Death Hospital, Institution or
Z City, Town or Village Town of Kingsbury Street Address 1119 State Route 196
0 Manner of Death [XI Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
°O
Address
Death Certificate Filed District Number Registejj Number
City, Town or Village Town of Kingsbury 5762 /(o
❑Burial Date Cemetery or Crematory
ID Entombment November 21, 2012 Pine View Crematorium
Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
2 I I Removal and/or Held
and/or Address
H Hold
CO
O Date Point of
NF I Transportation Shipment
p 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
1:.; Remains are Shipped, If Other than Above
2 Address
W
'D Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 114 0 ,o l j Registrar of Vital Statistics �P c. C:J ?_s?_.e
(signature)
District Number 576 Li Place Town of Kingsbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition Iii/Li iiL Place of Disposition -1?1,401,; Ce.rer4dt Jur.
2 (address)
W
N
CL (section) 1 k (lot number) (grave number)
p Name of Sexton or Person in Charge f Premises iA(i s (�.,, „,to
'Z (Tease print)
Signature Title
(over)
DOH-1555(02/2004)