Parsons, Christine L NEW YORK STATE DEPARTMENT OF HEALTH "Lp Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Christine L.Parsons Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/04/2022 79 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
Ul
W Manner of Death ❑X Natural Cause IllAccid El ent Suicide ❑Undetermined ❑Pending
Circumstances Investigation
1UMedical Certifier Name Title
Elizabeth Bessette NP
Address
152 Sherman Ave,Queensbury Town,New York 12801
DeaRth Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 169
Burial Date Cemetery,Crematory or Facility Name
11/09/2022 Pine View Crematory
Entombment Address
3 i IICremation Queensbury,New York
❑Donation
Z Date Place Removed
0 Removal
and/or and/or Held
N Hold Address
0
f. Date Point of
U) Transportation
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
Remains are Shipped,If Other than Above
Address
CC
CL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/09/2022 Registrar of Vital Statistics Caroline 7fi(1egarde Barber(E(ectronicaCCySigned)
(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:
IllDate of Disposition iiI1012L Place of Disposition .(!,,(L, 4....._......
2 (address)
W
MC (section) (lot numbe, \—. (grave number)
Name of Sexton or Person in Charges 'remises Ai —�4w�it
z /ease print)
fW Signature r Title r2iOn i gje(
DOH-1555(07/t8)p 1 of 2
Public Health Law Sec. 4145(2b) 1
1
1
1 Receipt
1
Human remains of delivered on , 20
1
1 Pine View Cemetery` Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#