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Magowan, Elaine L # 3� N EVI?YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elaine L Magowan Female Date of Death Age If Veteran of U.S.Armed Forces, 01/07/2022 91 Years War or Dates 1— Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 13 Greenwood Lane,Queensbury Town,New York 12804 U.1 Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined 0 Pending ILI Circumstances Investigation ILl Medical Certifier Name Title 0 Danielle Moriarity NP Address 3 Irongate Cenik,Glens Falls,New York 12801 Death Certificate+ iled District Number Register Number City,Town or Village Queensbury 5657 10 ▪Burial Date Cemetery,Crematory or Facility Name 01/12/2022 Pine View Crematory ❑Entombment Address O Cremation Queensbury Town,New York El Donation -`' 2 Date Place Removed 0❑Removal -.- and/or and/or Held 1... Hold Address s,Transportation Date Point of 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 -. Remains are Shipped,If Other than Above 2 Address Q W O., Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/12/2022 Registrar of Vital Statistics Caroline x(4Tegarie 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: Date of Disposition I/13IZZ Place of Disposition ?4.. V— (address)UJ W IE (section) (lot number) (grave number) g Name of Sexton or Person in Charge of Premi 'M -- M tr- Z (pleas print) /p� W Signature Title (, PfirliiP DOH-1555(07/18)p 1 of 2 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# 1 w