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Neal, Alta I') NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Alta Neal Female Date of Death Age If Veteran of U.S.Armed Forces, 12/18/2021 85 Years War or Dates Navy Place of Death Hospital,Institution or LU City,Town or Village Queensbury Town Street Address 32 Pinello Road,Queensbury Town,New York 12801 'p Manner of Death ©Natural Cause Accident ElHomicide ❑Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title O Douglas Dennett MD Address 101 Ridge Street,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 245 Burial Date Cemetery,Crematory or Facility Name 12/21/2021 Pine View Crematory ❑Entombment Address . 1 Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held t Hold Address 0 O. Date Point of ❑ U) Transportation p 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 ,a Address It W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/20/2021 Registrar of Vital Statistics Caroline ffi(fegarde Barber(ECectronicalty 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:Z /+./,I71 �fav+1 Date of Disposition �2�Z{ I Z� Place of Disposition t��„_ 2 (address) ILLI N (section) //J /lot number) cvvviti (grave number) � `ill 8 Name of Sexton or Person in Charge of Premis s ' Z (p/ea e print) W Signature � 7� Title rof'M I0c � / DOH-1555(07/18)p 1 of 2 ` ,.5460 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#