McNally, Catherine �Fj # 6ZC
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records `
Name First Middle Last Sex
Catherine McNally Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/05/2022 88 Years War or Dates
F. Place of Death Hospital,Institution or
WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
p Manner of Death I:INatural Cause Accident Homicide OSuicide ❑Undetermined ri Pending
W
(, Circumstances Investigation
W Medical Certifier Name Title
a Came Miron
PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 59
Burial Date Cemetery,Crematory or Facility Name
'.... 08/06/2022 Pine View Crematory
Entombment Address
)Cremation Queensbury,New York
Donation
Z Date Place Removed
0❑Removal
p and/or and/or Held
CD Hold Address
2 Date Point of
(I►)❑Transportation
5 by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
EReinterment 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
E.. Remains are Shipped,If Other than Above
-2 Address
I
MA
CL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/05/2022 Registrar of Vital Statistics Aimee L Mahoney(EfectronicaffySigned)
/signature/
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition g I t?I tt Place of Disposition . c,,, v/—, A77fu..�
2 (address)
W
Q (section) dr, //ot number/ /grave number/
8 Name of Sexton or Person in Charge of Premises �'-- t t�
Z ) lease print)
W Signature / Title __-.. l'V ►WCOI
2
DOH-1555(07/18)p 1 of 2
1
r
Public Health Law Sec. 4145(2b)
1 Receipt
1 Human remains of ,2 livered on , 20 "
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#