ST. Denis, Sandra Lee (r,.--LF 4 ROC
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records `.\,.. • -
Name First Middle Last Sex
Joyce Eileen Hill Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/07/2022 87 Years War or Dates
H Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 24 Rhode Island Avenue#1,Queensbury Town,New York 12804
p Manner of Death n Natural Cause lilAccident Homicide Suicide Undetermined Pending
W ' I U Circumstances Investigation
W Medical Certifier Name Title
0 Scott Miller PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 147
IllBurial Date Cemetery,Crematory or Facility Name
10/11/2022 Pine View Crematory
Entombment Address
nCremation Queensbury,New York
Donation
o❑Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
EL Date Point of
U)OTransportation
CI Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
El 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
E Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/11/2022 Registrar of Vital Statistics Caroline 7fiCdegarde Barber(ECectronicalTySigned)
(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:
lZL Date of Disposition 10111 I Zt Place of Disposition _4 -- 24-0,_
2 (address)
W
U)
CC (section) J (lot number/ (grave number)
elName of Sexton or Person in Charge Premises r'1Lk- l
Z please print)
W Signature Z — - Title (Ceini-
DOH-1555(07/18)p 1 of 2
E,) ? z_
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#
/OE
NEW YORK STATE DEPARTMENT OF HEALTH Burial•Transit Permit
Bureau of Vital Records
jName fiat Middle Last Sex
Sandra Lea St Danis F.
Date of Death Age If Veteran of U.S.Armed forces,
10/07/2022 72 Years Waror Dates
Place of Death Hospital Institution or
City,Town or Village South Ohms Fait,VIIoOe Street Address 52 lAidn Sliest 4.Smith Glens Feb VNlaps.New Yon(12803
Manner of Death D Nelurol Cause �/lcodent Homicide Suicide �Undetermintd Pending
W Circumstances Investigation
1/1Medical Certifier Name Title
CI Lauds Dennison tP
Address
3 konpsts Cerise.Glens Fags,New Yort 12801
Death Certificate filed Vases Of south Gi rw Fri District Number Register Number
Cit ,Town or Villa" 4824 8
Date Cemetery,Crematory or Facility Name
Burial
1011/2022 vine View Cresnstoty
Enbmbment Address
Eiremadon Ousenebu g Town,Now Yore
Donation
= Removal Date Place Removed
and/or and/or Held
~' Hold Address
Date Point of
jtransportetion
p by Common Shipment
Carrier Destination
Date Cemetery Address
DisintermeM
Date Cemetery Address
PfleiMerment
Permit Issued to Registration Number
Name of Funeral Home M B sewer Funeral None-South Owe Folio 01078
Address
138 Main St 8 Glens Falls.New York 12803
Name of Funeral firm Making Disposition or to Whom
1— Remains are Shipped.If Other than Above
Address
Permission Is hereby granted to dispose of the human remains described above as Indicated.
Date Issued IW1112022 Registrar of Vital Statistics .Srawsai,fiir8irvEisaso,esist*Arres
/s*satarr/
District Number 432e Place Viso.Of South Gists FaNs
I certify that the remains of the decedent identified above weir disposed of in accordance with this permit on:
t
Date of Disposition /O fr.4 11 Place of Disposition
- ,.
anuisn laY rw,r e i /, � l
Name of Sexton or Person in Charge miser � 1-r
W Signature / p
Title _ atiA N 7(
DOH-t555(o7/18)p t of 2
TO 39dd el3W1IAEW 817SLLPLBtS SZ:00 ZZOZ/Tt/OT
!!! 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#