Sennett, Irma NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
f%' Name First Middle Last Sex
Irma R. Sennett Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 20,2012 73 War or Dates
('': Place of Death Hospital, Institution or
City, VillageGlens Falls Hospital
Town or Glens Falls Street Address _
Manner of Death ❑X Natural Cause U Accident ❑Homicide ❑Suicide Undetermined 1-1 Pending
Circumstances Investigation
Medical Certifjer , Na�1 � Title
s Address '
,,: Death Certificate Filed ► District Number Registe Number
� , W
'% City, Town or Village Glens Falls,NY 5601
❑Burial Date Cemetery or Crematory
❑Entombment July 27,2012 Pine View Crematory
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z 1-1 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
Renterment Date Cemetery Address
%Yt 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
I'r Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued '7 ) , -4 J i - Registrar of Vital Statistics LA)CA'A— —Q. k-A-)
(signature)
District Number Place
5601 Glens Falls,NY /2r0/
I certify that the remains of the decedent identified above were disposed of in accordancerd/'� with this permit on:
W Date of Disposition 7/311a. Place of Disposition '(�n.VtiJ Cm►6tIto—
W (address)
co
tY (section) (lot number) (grave number)
QName of Sexton or Person in Charge of Premises A, r J`iimil-
wZ (please print)
Signature 1,-- Title Cnjrh4-ilM.
(over)
DOH-1555(02/2004)