Bardin, Laura L NEW YORKSTATE DEPARTMENT DFHEALTH 4111111
fi 27
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last
Sex
Laura L.Bardin Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/03/2022 160 Years I War or Dates
i— Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital
Man nerof Death 0 Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined ❑Pending
W
V Circumstances Investigation
WW Medical Certifier Name Title
0
Jacqueline Smith DO
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed city Of Saratoga Springs District Number Register Number
Cit ,Town or Village 4501 211
Burial Date Cemetery,Crematory or Facility Name
04/05/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
p and/or and/or Held
N Hold Address
0
O. Date Point of
N❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
DReinterment
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
E-- Remains are Shipped,If Otherthan Above
S Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/05/2022 Registrar of Vital Statistics 0)Zstt Mow:(2:Gch2mua4'S
(signature/
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 41(11,1 ZZ Place of Disposition
�JL ,./1Z....
a (address)
W
CO (section) d
(/ot number/ c it(gran,number)
8 Name of Sexton or Person in Charge of Premises
%�+�1
Z /p/ee print) ` ;��W Signature ZI Title ` Pt M�twt
DOH 1555(o7/18)pi of 2
C.
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#