Springer, Kathleen Rosemary . ,,_ ii.C.F.)-- 41 (17
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kathleen Rosemary Springer Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/30/2022 68 Years War or Dates
ZZ Place of Death Hospital,Institution or
UJ
City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing
p Manner of Death a Natural Cause Accident El Homicide ESuicide Undetermined ❑Pending
W
U Circumstances Investigation
GMedical Certifier Name Title
Shardul Koppar DO
Address
17 Madison St,Granville Village,New York 12832
Death Certificate Filed Village Of Granville District Number Register Number
City,Town or Village 5725 37
Burial Date Cemetery,Crematory or Facility Name
. 09/01/2022 Pine View Crematory
Entombment Address
aCremation Queensbury,New York
Donation
❑Removal Date Place Removed
H and/or and/or Held
N Hold Address
0
O. Date Point of
(/)ETransportation
a 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
Address
CC
W
0. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/01/2022 Registrar of Vital Statistics Diana Scartotta(Electronically Signed)
(signature)
District Number 5725 Place Village Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
A---W Date of Disposition 11 ZZ Place of Disposition
i (address)
W
U)
Q (section) (lot number) (grave number)
S Name of Sexton or Person in Charge of Premi p3 &mad
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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#