Craft, Phyllis i _1, li 3 to y
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
: J Name First Middle Last Sex
{ : Phyllis J Craft Female
: Date of Death Age If Veteran of U.S. Armed Forces,
:{ September 1, 2014 90 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
• Manner of Death
X Natural Cause Accident I 1 Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
� . James North Dr.
Address
' :▪ 100 Broad St,Glens Falls,NY 12801
▪ Death Certificate Filed District Number Register. Number /-
City, Town or Village Glens Falls 5601❑Burial Date Cemetery or Crematory
September 3, 2014 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F Hold
N
O Date Point of
O. Transportation Shipment
a by Common Destination
Carrier
(Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
•:r Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
▪ 407 Bay Road, Queensbury, NY 12804
r: 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 r mains des ibed abqve as i dicat:d.
Date Issued Q 6 aTi/ Registrar of Vital Statistics di —r,
Y▪ e (signature)
▪ District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were isposed of in accordance with this permit on:
Z Dispositioni' Disposition ,4r 6U.. C t-Itor
w Date of � S /� Place of
W (address)
CO
Ce (section) i -(lot numb (grave number)
Q Name of Sexton or Person in Charge of Premises zilort L h,Gi
`Z (jlease print)
SignatureA` Title rile mirk
(over)
DOH-1555(02/2004)