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Pottle, Betty M
4'686 NEW YORKSTATE DEPARTMENT OF HEALTH yt '` Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Betty M. Pottle Female Date of Death Age If Veteran of U.S.Armed Forces, 09/15/2021 67 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital ILIJ 13 Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined Pending tIJ Circumstances Investigation WMedical Certifier Name Title CI Sidharth Jogani MD Address 211 Church St,Saratoga Springs, New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 527 ❑Burial Date Cemetery,Crematory or Facility Name 09/16/2021 Pine View Crematory El Entombment Address iCremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held Hold Address 0 a Date Point of U) 11 Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom F.. Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/16/2021 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z Date of Disposition gf/7/__A:.i Place of Disposition �j/ti•t, �'it:w Crc .vq Y lil (address) W N CC (section) (lot number) (grave number) Name of Sexton or Pers n in Charge of Premises Tit g(D'rRS (please print) IL `� Title (,rUy,1ir Signature DOH-1555(07/18)p t of 2 1 z Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pme View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#