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Woodard, Mary IOF it NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary Woodard Female Date of Death Age If Veteran of U.S.Armed Forces, 03/24/2023 91 Years War or Dates Place of Death Hospital,Institution or Zz City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 163 Burial Date Cemetery,Crematory or Facility Name 03/28/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0 ElRemoval Date Place Removed and/or and/or Held pTh Hold Address A. Date Point of (1) Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address El 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 Lu CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/27/2023 Registrar of Vital Statistics Megan No(in(ECectronically Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 31n h �V w.�3 Place of Disposition , r40< 2 (address) W N LC /(section) /J (lot number) (grave number) O Name of Sexton or Person in Charge f Premises 'h/r'v ea �l it ease print W Signature _ Title 1.1 011 DOH-1555(07/18)p 1 of 2 • Public Health Law Sec. 4145(2b) I Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#