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Colvin, Cherilynn P
7 u 3 Li NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Cherilynn P.Colvin Female Date of Death Age If Veteran of U.S.Armed Forces, 04/14/2023 73 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Albany Street Address St Peters Hospital p Manner of Death ZI Natural Cause IllAccident ❑Homicide lilSuicide IllUndetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title Alicia Beardsley NP Address 315 S Manning Blvd,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 0913 Burial Date Cemetery,Crematory or Facility Name 04/17/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held • N Hold Address 0 a Date Point of N Transportation 3 by Common Shipment Carrier Destination Disinterment Date Cemetery Address 111 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 F_ Remains are Shipped,If Other than Above ▪ Address EC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/17/2023 Registrar of Vital Statistics rDanieaiSgileipre(E/ctronicallyStgned) (signature) District Number 0101 Place City Of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H WDate of Disposition 'Il$ ,.iIZ3 Place of Disposition �, 61---- (address) W CC CC (section) 4/ow (lot number) a (grave number) gName of Sexton or Person in Cha of Premises Z (p se print) W Signature Title DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) 1 .. .. Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#