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Priest, Sandra L.
93S" (,'''c\ NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sandra L.Priest Female Date of Death Age If Veteran of U.S.Armed Forces, 04/20/2021 81 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Kingsbury Town Street Address 3454 Burgoyne Avenue,Kingsbury Town,New York 12839 p Manner of Death ©Natural Cause 0 Accident El Homicide 0 Suicide El Undetermined 0 Pending Lu 0 Circumstances Investigation WW Medical Certifier Name Title ' Anne Evans DO Address 3 Irongate ter,Glens Falls,New York 12801 Death Ce„� led District Number Register Nt tier City,To t''':•e Kingsbury Town 5762 7 Burial ~ Date Cemetery,Crematory or Facility Name 04/22/2021 Pine View Crematorium Entombment Address 0 Cremation Queensbury Town,New York ElDonation ZRemoval Date Place Removed and/or and/or Held F- Hold Address N 0 O. Date Point of (A'❑Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/22/2021 Registrar of Vital Statistics Cynthia Bardin(ECectronica1Ty Signet) (signature) District Number 5762 Place Kingsbury Town, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— WDate Date of Disposition ejL-) jj / Place of Disposition {� r`de.__ 0, C(-Gm;�•-� 2 (address) W CC (section) (lot num en)cri (grave number) f Name of Sexton or Person in C rge of Prem. s i�a/I??f r l E! F Z (please print) IQ Signature 1:-' d Title Q Vei?t DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) ti 2 4 7? Receipt 1 Human remains of delivered on , 20 1 I Fine View Cemetery Representing the funeral home named on burial permit i Official Funeral Directors Reg.or License# 1