Crannell, Vera NEW YORK STATE DEPARTMENT OF HEALTH " - s
Vital Records Section P , Burial - Transit Permit
<5- Name First Middle Last Sex
r Vera G. Crannell Female
„r
< n.: Date of Death Age If Veteran of U.S. Armed Forces,
June 10,2013 87 War or Dates
r' Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death Natural Cause Accident Homicide n Suicide n Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
,, Daniel Larson,MD
Address
''`r 9 Carey Road,Queensbury,NY 12804
I DDeath Certificate Filed District Number Register Number
City, Town or Village Fort Edward,NY .T75T5 3_3
❑Burial Date Cemetery or Crematory
❑Entombment June 12,2013 Pine View Crematory
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
t" Hold
N
0 Date Point of
85 0 Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
F Permit Issued to Registration Number
VI Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
ON 407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
. Remains are Ship
ped, If Other than Above
Address
Permission is hereby granted to dispose of the hu r mai escribe o e as indicated.
Date Issued -/ 1V/3 Registrar of Vital St tistics
(signature)
;=_-- District Number.1.7-7525 Place Fort Edward,NY
Y fii
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w2 Date of Disposition Colo(t3 Place of Disposition &kk.. er taw,._
(address)
111
C6
Zre (section) // (lot umber) e''' (grave number)
Name of Sexton or Person in harge of Pre ises 1►,> _ JQvNcil-
(pl ase print)
W Signature L �- Title CliCh Alit
(over)
DOH-1555(02/2004)