Vaughan, Gabrielle 1
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NEW YORKSTATE DEPARTMENT OF HEALTH -u Burial - Transit Permit
Bureau of Vital Records __,
Name First Middle Last Sex
Gabrielle Vaughan Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/14/2023 84 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Glens Falls Street Address Glens Falls Hospital
a Manner of Death EI Natural Cause Accident El Homicide 0Suicide Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Aaron Heckler PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 36
Burial Date Cemetery,Crematory or Facility Name
01/20/2023 Pine View Crematory
Entombment— Address
Cremation Queensbury, New York
Donation
*0 Removal Date Place Removed
—� and/or and/or Held
aHold Address
Transportation Date Point of
a by Common Shipment
Carrier Destination
Date Cemetery Address
., Disinterment
,,,pReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
1 407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
11 Address
tem
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/19/2023 Registrar of Vital Statistics Megan Noan(ECectronica1Ty Signed)
(signature)
District Number 5601 Place City Of Glens Falls
x, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 0/23113 Place of Disposition l µ� I 1 ___
W
a (address)
W
(section) (lot number) (grave number)
n Name of Sexton or Person in Charge o ises7 N' �7
lease print/
Signature
Title (P6N Mt,
DOH-1555(o7/18)p 1 of 2
- 01.6 ',$) i
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#