Deeb, Irene NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Irene Deeb Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/05/2022 87 Years War or Dates
p. Place of Death Hospital,Institution or
WI City,Town or Village Saratoga Springs Street Address Saratoga Hospital
W Manner of Death ❑X Natural Cause ❑Accident Homicide El Suicide Undetermined ❑Pending
Circumstances Investigation
WMedical Certifier Name Title
n Derek Smith MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 17
ElBurial Date Cemetery,Crematory or Facility Name
01/12/2022 Pine View Crematory
ElEntombment Address
0 Cremation Queensbury Town,New York
Donation
Z Removal and/or Date Place Removed
52 El and/or Held
NF Hold Address
0
O. Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
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
1- Remains are Shipped,If Other than Above
a Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/07/2022 Registrar of Vital Statistics Dillan Moran(E/ctronicaf 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:
W Date of Disposition I /13 in Place of Disposition7. ,.��� r.. J-pd c+
(address)
W
fA (section) (lot number) (grave number)
gName of Sexton or Person in Charge of Premise t" �
z lease print)
• Signature c/ l Title 67'FM'I)'
DOH-1555(07/18)p t of 2
; 5 i.1
Public Health Law Sec. 4145(2b)
Receipt
1 Human remains of i delivered on , 20
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#