Hunt, Murvette NEW YORK STATE DEPARTMENT OF HEALTH 4t i✓ I
Vital Records Section • — Burial - Transit Permit
Name First Middle Last Sex
Murvette E. Hunt Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 9, 2013 77 War or paths
i.. Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address 14 Pollazzo Court
'p Manner of Death Natural Cause pi Accident n Homicide Suicide pi Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Pout
K � Title
G P �Pr�M.) Lib
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Death Certificate Filed Queensbury District Number Re ister Number
City, Town or Village 5657
❑Burial Date Cemetery or Crematory
March 12, 2013 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
ZO n Removal and/or Held
and/or Address
F' Hold
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O Date Point of
Ph ❑Transportation Shipment
p by Common Destination
Carrier
U Disinterment Date Cemetery Address
Li Renterment 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
1,-, Remains are Shipped, If Other than Above
a Address
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Permission is hereby granted to dispose of the human r m insin described ab s indicated.
Date Issued `- )c3-' i,)Registrar of Vital Statistics `'` q . .".„
(signature)
District Number 5657 Place Queensbury
I certify that the remainss of the decedent identified above were disposed of in accordance with this permit on:
Z Disposition -- c�3 Alit_ Vik,g./W Date of Place of Disposition fry ,,//
2 address)
W
co
re (section) ' �/� I t nu ber) (grave number)
gName of Sexton or ers in h ge of Premises +4/WY,a
Z (please print)
Signature Title 07
(over)
DOH-1555(02/2004)