Krulik, Isobel it ti
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
l' Name First Middle Last Sex
i— Female
Isobel Krulik
Date of Death Age If Veteran of U.S. Armed Forces,
s
1z/sv2o18
a 77 Years War or Dates
Place of Death Hospital, Institution or
Z. City, Town or Village Queensbury Townla Street Address The Stanton Nursing And Rehabilitation Centre
Manner of Death rzglaj Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined �Pending
Circumstances Investigation
uji Medical Certifier Name Title
Wendy Steinhacker PA
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
iiiii
it City, Town or Village Queensbury 5657 182
❑Burial Date Cemetery or Crematory
01/02/2019 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
it Date Place Removed
"—land/or Removal and/or Held
Address
Hold
Date Point of
t.❑Transportation Shipment
by Common Destination
7 Carrier
° Date Cemetery Address
it Q Disinterment
Reinterment Date Cemetery Address
iii
Pi Piii Permit Issued to Registration Number
tea.
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
44, Address
407 Bay Rd,Queensbury, New York 12804
;- Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
° ' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/02/2019 Registrar of Vital Statistics Caroline.7(Barber(ECectronicaC(ySigned)
,E (signature)
iit District Number 5657 Place Queensbury, New York
144,
-'''° I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Uil Date of Disposition j'tj Ili Place of Disposition Z..I_.., 1 --
(address)
(section) (lo/4inumber) C (grave number)
Name of Sexton or Person in Charge of Premises `htl Jpnr•t'
Z; ✓� (please rint)
▪ Signature G� Title `1/ r%..
J ti
(over)
DOH-1555 (02/2004)
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 7-a.y-'4 Place of Disposition P► Y i t.� cct,r c (c Y
W (address)
co
rt (section) (lot number) (grave number)
OName of Sexton or Person in Charge of Premises J Ar ,y Sre),:ir4A-
z
(please print)
tU Signature � .. ! ' Title CiFc,N+ is 0C
(over)
DOH-1555 (02/2004)