Condon, Christine Ann - tier
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Christine Ann Condon Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/05/2020 79 Years War or Dates
i_ Place of Death Hospital,Institution or
IllCity,Town or Village Glens Falls Street Address Glens Falls Hospital
G Manner of Death ❑X Natural Cause 0 Accident 0 Homicide ❑Suicide Undetermined Pending
W 0 Circumstances Investigation
W Medical Certifier Name Title
G Jeremy Di Bari MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 498
Burial Date Cemetery,Crematory or Facility Name
11/06/2020 Pine View Crematory
IDEntombment Address
gCremation Queensbury,New York
EIDonation
0 Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
LL 1-1 Date Point of
(1) ❑Transportation Shipment
Q by Common
Carrier Destination
❑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
I Remains are Shipped,If Other than Above
"i Address
IC
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/06/2020 Registrar of Vital Statistics 906ertJ nrlrew Curtis(& ctronicaf Signed)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition %/7-2czj Place of Disposition A L (1;;,gi,, C/ag"„-4 r'"(
WI
2 (addrege
W
W (section) (tot nu berl (grave number)
CC '/
8 Name of Sexton or Person in Charg f Premises r k l ' U/1 e/ lily
Z (please print)
W Signature �� %� Title D��'T ���
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) - 14177
Receipt
Human remains of delivered on E ' , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#