Celeste, Gail Marie _pi eta_
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Gail Mane Celeste Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/20/2022 86 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
,p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
0 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 79
Burial Date Cemetery,Crematory or Facility Name
10/22/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
Hold Address
O
fL Date Point of
f/) Transportation
ES 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
E_. Remains are Shipped,If Other than Above
rM Address
CC
W
IL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/21/2022 Registrar of Vital Statistics Aimee L 94afioney(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 I0124 I 1L Place of Disposition kAV
2 (address)
W
Q (section) (tot number) Suw4 (grave number)
Name of Sexton or Person in Charge o mises '' 11
(o Se
Z (prise print)
W Signature Title �1 0rm
DOH-1555(07/18)p t of 2
p 6 5 0
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on t ' , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#