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Butler, Kathryn M
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathryn M Butler Female Date of Death Age If Veteran of U.S.Armed Forces, 07/05/2022 85 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital 0 Manner of Death Undetermined Pending 11.1 El Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title 0 Matthew Collin Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 1559 X Burial Date Cemetery,Crematory or Facility Name 07/11/2022 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation ZO o Removal Date Place Removed and/or and/or Held H Hold Address 0 a Date Point of U)❑Transportation p 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 F Remains are Shipped,If Other than Above a Address Q W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/07/2022 Registrar of Vital Statistics Danielle S Gillespie(E(ectronicaltySigned) /signature) District Number 0101 Place City Of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 1. Place of Disposition chi taigA Rap © t.j r S.l f'1 �\.\ l&804 2 (address) (J W Ai- ► (sect" (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises ors >n e CC3<-- Z p (please print) LU Signature I� +C, l Title �`1 ' tlY-1Qe.11.'t- DOH-1555(07/18)p 1 of 2 1 IPublic Health Law Sec. 4145(2b) 012929 Receipt 1 -1/2-\n r 4, Human remains of V'<11-, delivered on , 20 22 Pine View Cemetery epresent. g the funeral home name on bu�al permit Official Funeral rectors Reg.or License#- /d BUTLER (14!) Lot No. o_A ddress 43 Surrey Field Drive , Queensbury . NY 12804 Section No. wner Kathryn M . Butler Plot Abenaki ate 9/ 1/00 Approx . 200 Superficial ft. @ xation Bounded on North by McDermott , Mitchell , Vacant , Leahy , South by Vacant , East by Lemmo i 643st by 'Brown . Drner Posts emarks eed No. (and changes) 3050 lyment Record Paid in Full 9/1/00 ($2 , 100 . 00) • ecord of Interments /1 i V C1 yrie Stantnn Riit1 er 9/7R/nn D / 1 A/ 3A) Betty Dayton (8/31/2010) Crem. ull ,--z.--- ,rm No. 01 BUTLER NAME Kathryn M Butler Age: 85 Lot Owner: Kathryn M Butler Lot# Abenaki 8 A Grave# 4 Case: Concrete Died: 7.5.2 2 Interred: 7. 1 1 .2 2 Funeral Home: Singleton Sullivan Potter Cemetery: Pine View