Abbott, Abraham NEW YORKSTATE DEPARTMENT OF HEALTH / Burial - Transit Permit
Bureau of Vital Records
`""' Name First Middle Last Sex
Abraham Abbott Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/22/2022 98 Years War or Dates 1943-1945
Place of Death Hospital,Institution or
City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
Iii
Manner of Death Z Natural Cause Accident El Homicide Suicide I=IU Pending
Circumstances Investigation
Medical Certifier Name Title
Carrie 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 87
X Burial Date Cemetery,Crematory or Facility Name
12/03/2022 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
*
Removal Date Place Removed
and/or and/or Held
44. Hold Address
41
10)
p
Transportation Date Point of
by Common Shipment
Carrier Destination
r III Disinterment Date Cemetery Address
;'ti Reinterment Date Cemetery Address
' Permit Issued to Registration Number
:s 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
`' Remains are Shipped,If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/30/2022 Registrar of Vital Statistics .Aimee L Mahoney(ECectronica1ty Signed)
(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 i D 3- a Place of Disposition 0 .1 q,lQ\•{ 9...{) evu c 413604
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2 (address)
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IW R/e c,A
/section (lot number) (grave number)
Name of Sexton or Person in Charge of Premises L—�nn,e ��<1 .-f-
-- (please print/
Signature4.4.4.4 ; Title .} 11deClt,
DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b) 012956
Receipt
Human remains of , delivered on , 20
41/
e Vi w Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
ABBOTT ,,
NAME Abraham Abbott Age: 98
Lot Owner: Abraham & Janet Abbottt
Lot# Erie 20 A Grave# 1
Case: Concrete
Died: 1 1 .2 2.2 2 Interred: 1 2 .3.2 2
Funeral Home: Regan Denny Stafford
Cemetery: Pine View