Audette, George # 552._
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
George R. Audette Male
Date of Death Age If Veteran of U.S. Armed Forces,
October 9,2012 90 War or Dates World War II
Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center
ci Manner of Death ❑X Natural Cause ElAccident n Homicide ❑Suicide n Undetermined Pending
USCircumstances Investigation
g. Medical C 'fiers-f,,,Name MO Name
Address _
C 'c rip(.."''WV (2�6(,6,
;x: Death Certificate Filed trict Number Register Numbe
City, Town or Village Saratoga Springs,NY �0/ tH&
❑Burial Date Cemetery or Crematory
❑Entombment October 16,2012 Pine View Crematory
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
ZO ❑Removal and/or Held
and/or Address
H Hold
N
O Date Point of
N ❑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
ii+° Remains are Shipped, If Other than Above
' Address
Permission is he eby granted to dispose of the human remains sc ;rats in icated.
:: Date Issued /Q // oU/7 , Registrar of Vital Statistics
(signature)
District Number 5/,5--0/ Place Saratoga Springs,NY
I certify that the remains of the decedent identified above were disposed of in accordance' with this permit on:
W Date of Disposition Io-is-i1 Place of Disposition .� rd
O(04 (,t torW—
E (address)
W
rA
re (section) //r (lot nu ber) (grave number)
pName of Sexton or Person in Charge of Premises ri�1 L �Q�►{(}-
Z I (please print)
W Signature ,t . -- Title CQeA1 A—ng.
I
(over)
DOH-1555(02/2004)