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Steves, Madeline NEW YORK STATE DEPARTMENT OF HEALTH v It ge Vital Records Section Burial - Transit Permit Name First Middle Last Sex Madeline M. Steves Female Date of Death Age If Veteran of U.S. Armed Forces, November 5, 2012 82 War or Dates n/a Place of Death Hospital, Institution or City, Town or Village Queensbury Street Address Stanton Nursing &Rehab Centre MI a Manner of Death I XI Natural Cause Accident —Homicide Suicide Undetermined Pending w Circumstances Investigation nW Medical Certifier Name Title 0 Roslyn Socolof,MD Address 152 Sherman Ave.,Queensbury,NY ;' Death Certificate Filed District Number Register Number City, Town or Village Queensbury,NY 5657 ( C)> ❑Burial Date Cemetery or Crematory November 8, 2012 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road, Queensbury, NY 12801 Date Place Removed Z I I Removal and/or Held and/or Address H Hold N 0 Date Point of NI I Transportation Shipment p 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 Name of Funeral Firm Making Disposition or to Whom t Remains are Shipped, If Other than Above 2 Address Ird HI I;L Permission is here y granted to dispose of the huma remains described a ¶v as indicated. i Date Issued ` 1I la, Registrar of Vital Statistics a, 4--t- (signature) District Number 5657 Place Queensbury,NY 13 V I certify that the remains of the decedent identified above were disposed ofin accordance with this permit on: W Date of Disposition till hi_ Place of Disposition -P,�c eu ( Cru._.' (aess W CO W (section) 4 a (lot number) (grave number) pName of Sexton or Person in Char a of Premises r,t} e'i Z please print) W Signature Title (-Lam 6 (over) DOH-1555(02/2004)