De Nardo, Joanna P 5(17
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joanna De Nardo Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 22, 2012 S War or Dates
: Place of Death Hospital, Institution or
City, Town or Village asfax-)Sk(AN\ � Street Address 84 Barthel Lane
Iii
It Manner of Death I XI Natural Cause n Xcciden1- Homicide Suicide n Undetermined Pending
US Circumstances Investigation
' Medical CA rtifier Name Title
P., rc..,\ CMb1 ;AGl, 0
Acidiess
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Death Certificate Filed District Number Register Number
City, Town or Village Queensbury,NY 5657 133
❑Burial Date Cemetery or Crematory
❑Entombment October 24, 2012 Pine View Crematory
Address
0 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO I Removal and/or Held
and/or Address
H Hold
CO
O Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
n 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
t Remains are Shipped, If Other than Above
N Address
.▪ Permission is hereby granted to dispose of the human remains described ab �ve as indicated.
i 0I23)a g — Cl ( �V
Date Issued O Registrar of Vital Statistics 1 /kz_
a,,1 (signature)
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LIJ Date of Disposition t0-74,-IL Place of Disposition etuic u f�Nrrc'tor,--
W (address)
N
CZ (section) 4 (lot number) (grave number)
pName of Sexton or Person in Charg of Premises fi;1 IKNlt
Z d6please print)
W Signature Title Ct46,t'}iJ(L
(over)
DOH-1555(02/2004)