Ryer, Helen NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Helen Ryer Female
Date of Death Age ' If Veteran of U.S.Armed Forces,
11/28/2020 90 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 6 Spruce Court,Queensbury Town,New York 12804
ILI
`p Manner of Death a Natural Cause ElAccident ❑Homicide El Suicide 111 Undetermined 0 Pending
V Circumstances Investigation
W Medical Certifier Name Title
0 Madison Zuis NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 211
0 Burial Date Cemetery,Crematory or Facility Name
12/01/2020 Pine View Crematory
0 Entombment Address
lCremation Queensbury Town,New York
❑Donation
OZ 1-1
L jRemoval Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
U) j Transportation
Q by Common Shipment
Carrier Destination
ElDisinterment 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
i- Remains are Shipped,If Other than Above
Address
Ir
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/30/2020 Registrar of Vital Statistics Carolinexkfegarae Bar6er(EYectronicaf Signed,
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
7/14 ._
Z Date of Disposition (Z h a 10 Place of Disposition
W
2 (address)
W
CC (section) (lot number) (grave number)
13 Name of Sexton or Person in Charge of P anises n �-' �0'hAtiN'
Z (p�se print)
IJJ Signature Title (1144414-74.
DOH-1555(o7/18)p t of 2
a
Public Health Law Sec. 4145(2b) 014 2 4 7
Receipt
Human remains of delivered on `: i , 20
--
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#