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Finnegan, Janis Louise NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Janis Louise Finnegan Female Date of Death Age If Veteran of U.S.Armed Forces, 07/31/2021 84 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 1124 Ridge Road,Queensbury Town, New York 12804 U Manner of Death ©Natural Cause Accident Homicide ❑Suicide Undetermined1:1 Pending Circumstances Investigation lai G Medical Certifier Name Title John Stoutenburg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 158 ElBurial Date Cemetery,Crematory or Facility Name 08/04/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury,New York ElDonation ZEl Removal Date Place Removed and/or and/or Held N Hold Address 0 EL Date Point of U) L j Transportation b by Common Shipment Carrier Destination Disinterment 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 2 Remains are Shipped,If Other than Above Address CC W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/04/2021 Registrar of Vital Statistics Caroline 7fif&Cegarcfe Barber(E(ectronica((ySigned) (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: r w Date of Disposition 8i3'iu Place of Disposition JL Ac_ 2 (address) W (I) Cr (section) (lot number/ (grave number) A n 8 Name of Sexton or Person in Charge of remises i. 01 z / (pleas print W Signature /► Title iiitrvoivie DOH-1555(07/18)p 1 of 2 ) {,.i r 1 Public Health Law Sec. 4145(2b) Receipt • 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#