Ramsey, Myrtle L. 1371_
-
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Myrtle L Ramsey Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/29/2020 97 Years War or Dates
1,. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 8 Rozelle Street,Queensbury Town, New York 12804
W Manner of Death Undetermined Pending
W Natural Cause Accident Homicide 1=1Suicide
Circumstances Investigation
WMedical Certifier Name Title
0 Robert Love MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 233
❑Burial Date Cemetery,Crematory or Facility Name
12/31/2020 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
f- Hold Address
it!
w ❑Transportation Date Point of
p by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment Date Cemetery Adr ss
—
Permit Issued to Registration Number
' Name of Funeral Home Singleton Sullivan Potter Funeral Hon• 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
C
W
4:1" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/31/2020 Registrar of Vital Statistics Carolrnex(i%egarIe Bader glectronicallySigned
(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:
Date of Disposition /2—Zed/ Place of Disposition 62 A . ti 1 e� C,�.,i i
W (address) J
W
CC
(section) / (lot number) (grave num er)
gName of Sexton or Person in Char of Premise / L -RA /qv,s b E •L,De.9[7
z ,,_ Y ,,,...se print)
W Signature r` 7/ Title d .el�'LTT3<�
DOH-1555(o7/18)p 1 of 2 (f
1
Public Health Law Sec. 4145(2h) , 01436 3
Receipt
Human remains of ; delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#