Howe, Rebecca A 5�
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Rebecca A Howe Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/10/2021 66 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Queensbury Town Street Address 20 Howe Drive,Queensbury Town,New York 12804
▪ Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Curtis Gedney MD
Address
454 Glen Street,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 123
❑Burial Date Cemetery,Crematory or Facility Name
06/15/2021 Pine View Crematory
ElEntombment Address
Cremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
O
W 1-1 Date Point of
co Li Transportation
5 by Common Shipment
Carrier Destination
ElDisinterment 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
I— Remains are Shipped,If Other than Above
2 Address
fY
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/15/2021 Registrar of Vital Statistics Caroline 9fiCdegarcCe Barber(Electronically Signed)
(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:
W Date of Disposition (o 1l1 I ti Place of Disposition
2 (address)
W
CC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premi s t� L it
(pi e print)
W Signature Title `f-Vk( 4Y
DOH-1555 l07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014863
Receipt
Human remains of = delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#