Chrantrand, Rhonda Grace # till
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Rhonda Grace Chartrand Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/29/2022 50 Years War or Dates
1— Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address 11 D Katherine Street,Glens Falls,New York 12801
p▪ Manner of Death ❑x Natural Cause Accident Homicide lilSuicide Undetermined ❑Pending
Circumstances Investigation
O• Medical Certifier Name Title
Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 296
Burial Date Cemetery,Crematory or Facility Name
MINNS 06/02/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
Donation
gRemoval Date Place Removed
and/or and/or Held
- Hold Address
0
ta. Date Point of
Cl) Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
ElReinterment 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
1— Remains are Shipped,If Other than Above
a Address
W
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/02/2022 Registrar of Vital Statistics Megan Wolin(ECectronicatTySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
•
W Date of Disposition /2l 1 Z Place of Disposition FA/L. 9'c•_ .
2 ess)
W
Q
(section) (lot number) (grave number)
• Name of Sexton or Person in Charg of Premises f`t � ���
ZI(please print
tL Signature Title � ����
DOH-1555(07/18)p 1 of 2
V ,
p2 .,75b
Public Health Law Sec. 4145(2b)
•
, Receipt
j
Human remains of delivered on , 20 _-
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#