Spitzer, Sarah R. - # 2c"-)
NEWYORKSTATEDEPARTMENTOFHEALTH - Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sarah R.Spitzer Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/06/2021 90 Years War or Dates
F- Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 55 Sheridan Street,Glens Falls,New York 12801
w Manner of Death Undetermined Pending
W Natural Cause Accident Homicide Suicide
0 Circumstances Investigation
W Medical Certifier Name Title
fa Eileen Spinelli NP
Address
Carey Rd,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 135
Burial Date Cemetery,Crematory or Facility Name
03/10/2021 Pine View Crematory
0 Entombment Address
0 Cremation Queensbury,New York
❑Donation
Z 0 Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
Id Date Point of
In Li Transportation
Q by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
El 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
Address
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/10/2021 Registrar of Vital Statistics 906ert,Inarrew Curtis(Ekctronicaf 5gnet°
(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:
Z
W Date of Disposition 3 0 I.11 Place of Disposition `� C..........address/
W
Q (section) lumber) (grave number)
O Name of Sexton or Person in Charge of Prem. r c' ` ''�1
Z (pleas print)
W ( 'r
Signature Title
DOH-1555(o7/18)p 1 of 2
£r LL
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Offi ial Funeral Directors Reg.or License#