Winchip, Janice NEW YORKSTATE DEPARTMENT OF HEALTHLF) Burial - Transit Permit
Bureau of Vital Records ,,--1
Name First Middle Last Sex
Janice Marie Winchip Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/07/2022 81 Years War or Dates
H Place of Death Hospital,Institution or
W City,Town or Village Greenfield Town Street Address 100 Howe Road,Greenfield Town, New York 12833
p Manner of Death ❑X Natural Cause Accident Homicide Suicide ❑Undetermined El Pending
W Circumstances Investigation
WMedical Certifier Name Title
ID Anthony Petracca MD
Address •
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Greenfield District Number Register Number
City,Town or Village 4557 29
X Burial Date Cemetery,Crematory or Facility Name
11/17/2022 Pine View Cemetery
Entombment Address
Cremation Queensbury,New York
Donation
0Z El Removal Date Place Removed
and/or and/or Held
Fa Hold Address
2 Date Point of
• Transportation Shipment
es by Common
Carrier Destination
Date Cemetery Address
Disinterment
CI
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
p.. Remains are Shipped,If Other than Above
,,, Address
t
w
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/09/2022 Registrar of Vital Statistics wren S.<Dowen(ECectronicaCCy Signed)
(signature)
District Number 4557 Place Town Of Greenfield
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition \\ `—1•as Place of Disposition ` L )3 r OU,C hSUUM •N L I `T'
iu (address)CC
V
is / (lot number) (grave number)
g Name of Sexton or Person in Charge of Premises pnrl t e COe �
(please print)
tU Signature /�I�y,'` �C, y Title �i h c
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
012952
Receipt
Human remains of - delivered on \ ' t , 20 .•)
Pine View Cemetery Representing the funeral home named on huriarpennit
Official Funeral Directors Reg.or License#
WINCHIP
NAME Janice Winchip Age: 81
Lot Owner: Winchip
Lot# Oneida 17/20 Grave# 3
Case: Concrete
Died: 1 1 7.2 2 Interred: 1 1 . 1 7.2 2
Funeral Home: Regan Denny Stafford
Cemetery: Pine View
w I AcAt e Lot-Nol71?-20
Address Box 116 D, Schuylerville, N.Y. Section_Nd.
Owner Robert A. mas & Janice (. Lamb Plot Oneida
\,0;. � p
Date- - 1=1/ih/78
140 Superficial ft. @ $2.50 per sq. ft.
Location Bofided on the North by Vacant, East by Vacant, South by Path & Matteson, West by Road
Corner Posts
Remarks
Deed No. (and changes) 1510
Payment Record paw in fill, 11/.1)1/7R
Form No. 01 (i ')
Record of Interments
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