Loading...
Cogovan, Margaret Ann NEW YORKSTATE DEPARTMENT OF HEALTH 1(:: , Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margaret Ann Cogovan Female Date of Death Age If Veteran of U.S.Armed Forces, 05/28/2021 77 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Pending1=1 0 © Natural Cause ❑Accident Homicide Suicide ❑Undetermined W Circumstances Investigation W Medical Certifier Name Title CI Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 227 ©Burial Date Cemetery,Crematory or Facility Name 06/03/2021 Pine View Cemetery Ei Entombment Address ElCremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed 0 Eland/or and/or Held F— Hold Address N 0 a Date Point of to Li Transportation Shipment 5 by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address Reinterment 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 X Address Jr W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/02/2021 Registrar of Vital Statistics gWert Andrew Curtis(Electronically 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: I— Z Date of Disposition 6/3/2021 Place of Disposition 21 Quaker Rd. Queensbury, NY 12804 UJ 2 (address) alMohcian 89 B 2 CC ( ion) (lot number) (grave number) 0▪ Name of Sexton or Person in Charge of Premises Connie Goedert (please print) W Title Superintendent Signature die z DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012856 Receipt f Human remains of delivered on , 20-- /f Pine View Cemetery Representing the funeral home named on l?uriaFpermit Official Funeral Directors Reg.or License# Cogovan + NAME e: Margaret Ann Cogovan Age: 77 LI Lot Owner: Margaret Ann Cogovan Lot# Mohican 89b Grave# 2 Case: Concrete Died: 5/2 8/2 0 21 Interred: 6/3/2021 Funeral Home: Regan Denny Stafford Cemetery: Pine View