Greene, Nancy NEW YORK STATE DEPARTMENT OF HEALTH �1.
Vital Records Section Burial - Transit Permit
Name First Last Sex
, Nancy ;'• Greene Female
Date of Death Age If Ve •f U.S. Armed Forces,
12/31/2018 66 Wa • -tes n/a
4 Place of Death Hospi - , Institution or
City, Town or Village Queensbury " Street Address 17 Farr Lane East,Unit 222
Manner of Death ❑Natural Cause [Accident ❑Homicide ❑Suicide 1-1 Undetermined Pending
Circumstances Investigation
g Medical Certifier Name Title
Michael Sikirica,Coroner
Address
Albany,NY
Death Certificate Filed District Number Regi Itrumber
City, Town or Village Queensbury,NY 5657
❑Burial Date Cemetery or Crematory
❑Entombment January 7, 2019 Pine View Crematorium
Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
ZC ❑Removal and/or Held
and/or Address
H Hold
CO
0 Date Point of
Nn Transportation Shipment
p by Common Destination
Carrier
Date Cem •tery Address
❑Disinterment
❑Reinterment Date Cemetery Address
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
` Remains are Shipped, If Other than Above
Address
00
Permission is hereby granted to dispose of the human rem in e • o e in i ated.
k' Date Issued 1 -4-AO IQ Registrar of Vital Statistics
gnat
District Number S(Al Place D i1 n
I certify that the remains of the decedent identified above w e disposed of in acco ance ith this permit on:
Z I-.3- I/ Place of Disposition p,„Q v, ,,, 4 or::.�� Date of Disposition p L r"F��
2 (address)
COIli
pW (section) 1 jt number) (grave number)
Name of Sexton or Person in Charge of Premises / t c.l,�a IS`�.�. K
'Z (please print)
Signature 77� Title �r ep-Lke-
(over)
DOH-1555(02/2004)