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Stephens, Deborah A
4; . ...s.s. NEW YORK STATE DEPARTMENT OF HEALTH ",.s. Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Deborah A.Stephens Female Date of Death Age If Veteran of U.S.Armed Forces, 07/18/2023 58 Years War or Dates a,. Place of Death Hospital,Institution or Z City,Town or Village Ticonderoga Town Street Address 2432 NY-74 Route,Ticonderoga Town,New York 12883 UJ p Manner of Death ❑Natural Cause Accident ❑Homicide Suicide FlUndetermined Pending W V Circumstances Investigation W Medical Certifier Name Title G Kellie Valentine Coroner Address PO Box 132,Elizabethtown Town,New York 12932 Death Certificate Filed Town Of Ticonderoga District Number Register Number City,Town or Village 1564 42 ▪Burial Date Cemetery,Crematory or Facility Name 07/24/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ▪Donation 0❑Removal Date Place Removed - and/or and/or Held E—- Hold Address CO 0 O. Date Point of CO 111Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment 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 H Remains are Shipped,If Other than Above M Address Ill W G. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/24/2023 Registrar of Vital Statistics 7onya_qf Oompson(Ekctronically5rgned) (signature) District Number 1564 Place Town Of Ticonderoga I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- e•-..—' I Z Date of Disposition 7 IN 113 Place of Disposition i---,-AL —_ ILI 2 (address) W CO IX (section) at number) (grave number) B Name of Sexton or Person in Charge off (pleaseriot) Z /' W Signature Title ` izc 10v( DOH-1555(o7/18)p 1 of 2 ' j17i42 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on.burial p9rmit Official Funeral Directors Reg. or License#