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Cox, Deanna M r - li- lir NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Deanna M Cox Female Date of Death Age If Veteran of U.S.Armed Forces, 10/29/2021 75 Years War or Dates 1.„ Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 77 Yorkshire Drive,Queensbury Town, New York 12804 W Manner of Death © W Natural Cause ❑Accident ElHomicide ❑Suicide ❑Undetermined ❑Pending V Circumstances Investigation Q Medical Certifier Name Title Anthony Petracca MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 211 ❑Burial Date Cemetery,Crematory or Facility Name 11/02/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z• El Removal Date Place Removed - and/or and/or Held ~- Hold Address fa 0 Vag ❑Transportation Date Point of 5 by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment 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 I— Remains are Shipped,If Other than Above i Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/01/2021 Registrar of Vital Statistics CarofineJfi(fegardf Barber(ECectronicairySigned) (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 W Date of Disposition fl I Z ill Place of Disposition t�� -�1iQ{ M (address) W LA ac (section) number) (grave number) a Premises Name of Sexton or Person in Charge of Pre Aarot ., {�w1e4� (pleasrint) z r W Signature Title (r'� ' DOH-1555(07/18)p 1 of 2 .1 2 Public Health Law Sec. 4145(2b) IReceipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#