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Whitty, Tammy ACIF NEW YORK STATE DEPARTMENT OF HEALTH , Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Tammy Whitty Female Date of Death Age If Veteran of U.S.Armed Forces, 07/26/2023 60 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 85 Aviation Road,Queensbury Town, New York 12804 W Manner of Death ❑X Natural Cause Accident E Homicide Suicide ri Undetermined Pending Circumstances Investigation WMedical Certifier Name Title 0 Aqeel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 118 Burial Date Cemetery,Crematory or Facility Name 07/27/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York Donation 0 Removal Date Place Removed and/or and/or Held F- Hold Address N 0 0. Date Point of to❑Transportation p` 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 1_ Remains are Shipped,If Other than Above g Address a W AL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/27/2023 Registrar of Vital Statistics Caroline 2fifdegarde Barber(Electronically Signed) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 2-Zt223 Place of Disposition ei,r e d;e,,,) Cr�%rc W (addre1 W IA (section) (lot numb r) (grave number) �$ Name of Sexton or Person in Charge of mise 4/ o/4� �CI 14/ z ` �(please print) UJ Signature JL Title D( CSw DOH-1555(07/t8)p 1 of 2 n 71 94 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#