Loading...
Tracy, Joan Ann NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records i Name First Middle Last Sex Joan Ann Tracy Female Date of Death Age If Veteran of U.S.Armed Forces, 08/01/2021 80 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title O Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 159 ❑Burial Date Cemetery,Crematory or Facility Name 08/06/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury,New York ❑Donation ZO El Removal Date Place Removed p and/or and/or Held — Hold Address O d Date Point of U) ❑Transportation 8 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 t.. Remains are Shipped,If Other than Above 2 Address W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/06/2021 Registrar of Vital Statistics Caroline 2fildegaree Barber(ECectronicaCfySigned) (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: Z▪ Date of Disposition $�l("i;,I Place of Disposition J.ZLJ4.___/ dress/ W CC N (section) (lot numbeti-- } (grave number) GName of Sexton or Person in Charge of Pre ' es i'� '"y 11 Z (ease print) W Signature C/ Title rtpcgem DOH-1555(07/18)p 1 of 2 • a 1ti Z 5008 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#