Currie, John V # GIgZ
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John V Currie Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/13/2022 80 Years War or Dates
i_ Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 1133 Bay Road,Queensbury Town,New York 12845
p Manner of Death ❑X Natural Cause Accident 0 Homicide 0Suicide Undetermined ElPending
W Circumstances Investigation
W Medical Certifier Name Title
0 Eric Borden MD
Address
3044 Route 50,Wilton Town,New York 12866
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 99
Burial Date Cemetery,Crematory or Facility Name
06/15/2022 Pine View Crematory
Entombment Address
DCremation Queensbury Town,New York
Donation
o❑Removal Date Place Removed
- and/or and/or Held
H- Hold Address
N
0
a Date Point of
U)DTransportation Shipment
5 by Common
Carrier Destination
O
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
H Remains are Shipped,If Other than Above
2 Address
Q
W
CI. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/15/2022 Registrar of Vital Statistics Caroline 5111degarde Barber(E(ectronicallySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ZW Date of Disposition ivillblZL Place of Disposition �,`1L_
2 (address)
W
N CC (section) A (lot number) (grave number)
GName of Sexton or Person in Charge of Premises fit'�p ,cipti
Z (pt�ep print)
W Signature A __ Title V y Mp��
DOH-1555(o7/18)p 1 of 2
0Iv 88
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ' delivered on , 20
iPine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#