Turcotte,Mireille Jeanine NEW YORK STATE DEPARTMENT OF HEALTH .. r Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mireille Jeanine Turcotte Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/03/2020 90 Years War or Dates
N Place of Death Hospital,Institution or
W City,Town or Village North Greenbush Town Street Address Van Rensselaer Manor
p Manner of Death ❑X Natural Cause D Accident 1=I Homicide ❑Suicide ❑Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
a Gemma Bracy NP
Address
85 Bloomingrove Dr,North Greenbush Town,New York 12180
Death Certificate Filed District Number Register Number
City,Town or Village Wynantskill 4156 163
Burial Date Cemetery,Crematory or Facility Name
12/07/2020 Pine View Crematory
Entombment Address
gCremation Queensbury,New York
❑Donation
2❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
O
d Date Point of
0 ❑Transportation Shipment
C3 by Common
Carrier Destination
El
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
F, Remains are Shipped,If Other than Above
2 Address
Q
ill
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/06/2020 Registrar of Vital Statistics Janice Kerwin(Ekctronicallji Signed)
(signature)
District Number 4156 Place Wynantskill, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition IL n?/70 Place of Disposition R,fttl'_ Ace
W (address)
W
NMC (section) lot number) (grave number)
O Name of Sexton or Person in Charge of Pr ices f"tpl., ...-57NA4 i#
z pleas print)
W Signature Title �n�>k Mr1�,Q.
g
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) U if 2 7 0
Receipt
Human remains of i delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#