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Carey, Virginia M f NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Virginia M Carey Female Date of Death Age If Veteran of U.S.Armed Forces, 02/05/2022 90 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 31 Longview Drive,Queensbury Town,New York 12804 0 Manner of Death ©Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending In Circumstances Investigation § Medical Certifier Name Title Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 32 ❑Burial Date Cemetery,Crematory or Facility Name 02/08/2022 Pine View crematory El Entombment Address X❑Cremation Queensbury Town,New York ❑Donation ZRemoval Date Place Removed and/or and/or Held E— N Hold Address 0 O. to ❑Transportation Date Point of 5 by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address El 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 t Remains are Shipped,If Other than Above a Address C W Q' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/08/2022 Registrar of Vital Statistics Caroline WfifQegariecBar6er(E(ectronicalTySigned) (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 a—fir,Z Place of Disposition P j he v(,��,�/ Grp ri'�a6 y 21 (address) W CO (section) (lot number) (grave number) SName of Sexton or Person in Charge of Premises SeCm{,ii' SJ4 CIS z (please print) III) Signature Title Grc,A et4c1 DOH-1555(07/18)p 1 of 2 It 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#