McCollister, Linda Beals NEW YORK STATE DEPARTMENT OF HEALTH / Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Linda Beals McCollister Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/08/2022 81 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address 400 Church,Saratoga Springs,New York 12866
0 Manner of Death Natural Cause Accident ❑Homicide Suicide Undetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
CI Anne Evans DO
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 416
Burial Date Cemetery,Crematory or Facility Name
07/13/2022 Pine View Crematory
Entombment Address
Cremation Queenbury Town,New York
Donation
ZO nRemoval Date Place Removed
and/or and/or Held
H Hold Address
CO
O _
4. Date Point of
t!) Transportation
CI 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
1— Remains are Shipped,If Other than Above
M Address
LC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/13/2022 Registrar of Vital Statistics DiltOn Moran(ECectronica1TySigned)
(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 x. '7Ifstlt Place of Disposition � a--•
2 address)
CO
CC
(section) /7 number) C (grave number)
O Name of Sexton or Person in Charge of remises G/��`� �
Z (pie a print) � �,
W Signature _ Title r 141114
DOH-1555(o7/18)p t of 2
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#