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Krihak, Eleanor N tr 3 NEW YORK STATE DEPARTMENT OF HEALTH r Vital Records Section Burial - Transit Permit Name First Middle Last Sex Eleanor Marie Krihak Female Date of Death Age If Veteran of U.S. Armed Forces, December 30, 2014 91 War or Dates L.. Place of Death Hospital, Institution or 2 City, Town or Village Glens Falls Street Address 20 Elm Street Apt 503 fl Manner of Death n Natural Cause n Accident 1 'Homicide Suicide -Undetermined Pending IliCircumstances Investigation jin Medical Certifier Name Title ' Patricia Auer,PA Address Queensbury,NY Death Certificate Filed District Number Register Number City, Town or Village Glens Falls,NY 5601 ,0 1 ❑Burial Date Cemetery or Crematory ❑Entombment January 2, 2015 Pine View Crematorium Address ©Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed 2 `Removal and/or Held O `and/or Address I•" Hold U) O Date Point of Wn Transportation Shipment p by Common Destination Carrier Li Disinterment Date Cemetery Address Date Cemetery Address n Reinterment 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 Address 11,▪1 Permission is hereby granted to dispose of the human remains described above as indicated. . Date Issued 1 1 z) is Registrar of Vital Statistics L)C �/•..) (signatur ) District Number 5601 Place Glens Falls,NYY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w Date of Disposition ( M) '" Place of Disposition 'I 1 Ug CAN., W (address) N 0 (section) /� (lot num ) (grave number) ZName of Sexton or Person in Charge of Premises l��`�J L... riw W please print) SignatureA' Title 020011604 (over) DOH-1555(02/2004)