Hodges, Gail 11 jS
NEW YORK STATE DEPARTMENT OF HEALTH
illifi
Vital Records Section Bu I - Transit Permit
Name First Middle °111111111111Last Sex
Gail LaMoine Hodges Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/02/2018 79 Years War or Dates
1 Place of Death Hospital, Institution or
WCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
p Manner of Death X❑Natural Cause ❑Accident ❑Homicide 0 Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
w Medical Certifier Name Title
Q Carlos Ares MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
C. Town or Village Saratoga Springs 4501 140
DBurial Date Cemetery or Crematory
03/06/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
ari Removal and/or Held
and/or Address
li Hold
O Date Point of
a-0 Transportation Shipment
G by Common Destination
Carrier
,' Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1• Remains are Shipped, If Other than Above
a Address
ig
'CL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/05/2018 Registrar of Vital Statistics John c Tranck(cE(ectronica1Cy Signed)
(signature)
District Number 4501 Place Saratoga Springs, New York
F. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
FP IL .-.-�i MI Date of Disposition 311,ht Place of Disposition ,� ,_
g (address)
W
N re (section) /�l .(lot numb �^ (grave number)
Q Name of Sexton or Person in Charge of Premises `L
Z (lease pnnt)
W Signature 6 �-� Title `P&N'n%t?r-
(over)
DOH-1555 (02/2004)