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Francett, Betty NEW YORK STATE DEPARTMENT OF HEALTH if Vital Records Section Burial - Transit Permit Name First Middle Last Sex Betty Francett Female Date of Death Age If Veteran of U.S. Armed Forces, January 18, 2014 83 War or Dates H Place of Death Hospital, Institution or Z City, Town or Village Queensbury Street Address 48 Rainbow Trail pManner of Death r.71 LAI Natural Cause ❑Accident ❑Homicide n Suicide n Undetermined Pending VCircumstances Investigation WQ Medical Certifier Name Title Robert Evans Address Irongate, Glens Falls,NY 12801 Death Certificate Filed ' District Number Register Number City, Town or Village Queensbury 5657 LQ ❑Burial Date Cemetery or Crematory ❑Entombment January 21,2014 Pine View Crematorium Address ©Cremation 51 Quaker Road,Queensbury,NY 12804 Date Place Removed ZZ ❑Removal and/or Held and/or Address H Hold U) 0 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 I- Remains are Shipped, If Other than Above $ Address r W O. Permission is hereby granted to dispose of the human r i s descri'id%a.ov- -s ep icated. Date Issued I-, i-(3pt(-1. Registrar of Vital Statistics ' (sign.40 District Number 5657 Place Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z w Date of Disposition I /Ra//y Place of Disposition ZuI,;.) & lOtA._ 2 (address) W U) ZCL (section) A (lot number (grave number) Name of Sexton or Person in Charge of Premises (/ At( ir�4 ' 4,/,_ ( lease print) WSignatureTitle Cr2EisiiTX (over) DOH-1555(02/2004)