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Dimick, Margaret A
tt . i 3z3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margaret A.Dimick Female Date of Death Age If Veteran of U.S.Armed Forces, 04/06/2023 83 Years War or Dates Place of Death Hospital,Institution or Ill City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing W Manner of Death Ei Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G Joshua Starteri NP Address 17 Madison St,Granville Village,New York 12832 Death Certificate Filed Village Of Granville District Number Register Number City,Town or Village 5725 16 Burial Date Cemetery,Crematory or Facility Name 04/10/2023 Pine View Crematory Entombment — Address ©Cremation Queensbury,New York Donation 2 Removal Date Place Removed and/or and/or Held 0 Hold Address O Q. Date Point of (I)IIITransportation a by Common Shipment Carrier Destination Date Cemetery Address Disinterment 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 S Address GC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/10/2023 Registrar of Vital Statistics Diana Scartotta(ECectronicaCCy Signed) (signature) District Number 5725 Place Village Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition L tta 13 Place of Disposition --A. LU (address) 11.1 th CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Pre ises ' � �il�� j /ease print) W Signature Title F `arryN91 DOH-1555(o7/i8)p i of 2 ✓'f Public Health Law Sec. 4145(2b) Receipt 1 1 Human remains of delivered on , 20 1 1 1 Pine View Cemetery Representing the funeral home named on burial permit 1Official Funeral Directors Reg.or License#