Dansky, Esther C NEWYORKSTATE DEPARTMENTOFHEALTH F)' - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Esther C.Dansky Female
Date of Death Age If Veteran of U.S.Armed Forces,
07212022 87 Years Waror Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Fans Hospital
8 Mannerof Death EI Natural Cause ❑Accident El Homicide OSuicide Undetermined ❑Pending
iii
0 Circumstances Investigation
WW Medical Certifier Name Title
0 Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Village 5601 381
X Burial Date Cemetery,Crematory or Facility Name
07272022 Pine View Cemetery
Entombment Address
❑Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
FN Hold Address
n
fl ran sportation Date Point of
O by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
�Reinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Oueertsbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
t— Remains are Shipped,If Other than Above
2 Address
CC
O.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 0725f2022 Registrar of Vital Statistics lvan Nan(E.isaroeska451Sipma9
(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:
WDate of Disposition i,,� ,,: a Place of Disposition k Oi t.K,SKJ z Q� /1 tCJ`RS '
C ri ki t,
a (address/
y l;"Y1f�\r,rdw.�1� �� a
cclion/ (/ot number/ (gra►e number/
8 Name of Sexton or Person.n Charge of Prem. t'^flr‘t C� Cc,ec:,"A-
(phase print)
W Signature 4' Title 1�r c,--\Ut1aCA.-4-
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) u12931
Receipt
1 .Human remains of,' /- ' , - --'' ( ,1 7 delivered on. ' 7 '`. '' , 20; :--
I ---
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t ,, \
Pine View Cenietery s Representing the funeral home named on burial permit
, Official ) Funeral Directors Reg.or License#
40
DANSKY ( LAIF)
NAME Esther Age: 87
Lot Owner: Arnold & Esther DAnsky
Lot# Mohawk 75 Grave# 2
Case: Concrete
Died: 7.21 .2 2 Interred: 7 .2 7.2 2
Funeral Home: singleton Sullivan Potter
Cemetery: Pine View
DANSKY
�1 Lot No. 75
Address 74 Dixon Road, Glens Falls, N.Y. 12801 Section No.
Owner Arnold & Esther Dansky Plot Mohawk
Date 7/26/85
Approx. 100 Superficial ft. @
Location Bounded on North by Vacant, South by Myers, East by Prince & Hodge, West by Path.
Corner Posts
Remarks
Deed No. (and changes) 1946
Payment Record Paid in Full 7/26/85
Record of Interments
1 Arnold Dansky (11/2/2009) 741/
tA
4
5 X
6I
71
8 I •
o G g` pie/,f/c
Form No. 01