Hermance, Sandra Lee b1/11/2018 11:39 5183773446 LIGHTS FUNERAL HOME PAGE 01/01
NEW YORK STATE DEPARTMENT OF HEALTH r E
Vital Records Section Burial Transit Permit W 17
7
- Name First Middle Last Sex ,
iig SANDRA LEE NICOLE HERMANCE FEMALE
• Date of Death • Age if Veteran of U.S.Armed Forces, 1 •
01/08/2018 30 War or Dates
Piece of Death Hospital,Institution
Citty,,,Town or Yllacl City of Albany ..,,,or Street Address T.MARGARETS CENTER
IZSi cause u „"`""�" ,J �•• L�tie?tfT�2irre� l'Podic�(L,._--
Medical Certifier Name Title
ip
MARIA KANSAS DEVINE MD
tfli Address
yyt 314 SO MANNING BLVD.ALBANY NY 12208
4teath Certificate Filed District Number Register Number
alii City,Town or Village C. of Albany 101 0084
Date Cemetery or Crematory
Burial r s : PINE VIEW CREMATORY
Entombment Address --
I�i Cremation QUEEN •SBURY NY '
❑ Date 'Place Removed .
Removal and/or Held
F— and/or AddressF*- Hold
CO _ - _
Date I Point of
fl Transportation Shipment
;CO 0 By Common p Carrier Destination
❑ Disinterment
Date Cemetery Address
Date Cemetery Address
❑ Reinterment
k Permit Issued To Registration Number
N. Name of Funeral Home SINGLETON SULLIVAN POTTER FUNERAL HOME 01598
ry Address
ki 407 BAY ROAD, QUEENSBURY, NY 12804
Name of Funeral Finn Making Disposition or to Whom • •
Remains are Shipped,If Other than Above
A ress
.1r1'd Permission is hereby granted to dispose of the human remains described above as indicated.
f 01/11l2018 �� �
r" Date'
t`" Issued Registrar of Vital Statistics
,-_
(signature)
^,•.: District Number 101 Place City of Albany, NY
Ema
I certify that the remains of the decedent identified above were disposed of in accordancecop with this permit on:
Z, Date of Disposition I/!i IIf- Place of Disposition 1r..ctL (.+ � _
l (address)
Ili'
_o --
(section) lot number) (grave number)
.t Name of Sexton or Person In Charge of Premi ., S��tik
(please print)
Signature (_ Title ` _ Mit
(over)
DOH-1555(0212004) ,
ow, Town of Queensbury
Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Sandra Lee Hermance
were cremated on January , 17 20 18 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death January , 8 20 1 s Age 30
(Month) (Day)
Funeral Home Singleton Sullivan Potter Registered No. 49
(Authorized Signature)
PELKEY Lot No. 104
Address 3089 R T 9 L, LAKE G E O R G E NY 12845 (I Section No.
Owner THERESA & SHAWN PELKEY ' Plot ONEIDA
Date 1L1..„ i
APPROX . 33 Superficial ft.
Location BOUNDED ON NORTH BY LYNCH, SOUTH BY PATH, EAST BY STEWART,
WEST BY PATCH .
Corner Posts
Remarks NOTE ; RESERVED FOR SANDRA LEE HERMANCE
Deed No ;and changes) 3468
Payment Record PAID IN FULL 1/9/07 ( $550 . 00)
Record of Interments
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Form No. 01
HERMANCE ( LF)
NAME James Heramance Age: 82
Lot Owner: Theresa & Shawn Pelkey
Lot# Oneida 1 04 Grave# 2
Case: Urn
Died: 1 .7.2000 Interred: 9. 1 5.23
Funeral Home: Regan Denny Stafford
Cemetery: Pine View