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Loiselle, JoAnn Marie NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex JoAnn Marie Loiselle Female Date of Death Age If Veteran of U.S.Armed Forces, 08/31/2023 63 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 7 Orchard Drive,Queensbury Town,New York 12804 MI a Manner of Death ❑X Natural Cause Accident 0 Homicide Suicide Undetermined Pending VCircumstances Investigation Iu Medical Certifier Name Title G Christopher Mason DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 138 Burial Date Cemetery,Crematory or Facility Name 09/01/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury,New York Donation Z =IRemoval Date Place Removed and/or and/or Held Hold Address (I) Transportation Date Point of a by Common Shipment Carrier Destination Disinterment Date Cemetery Address a 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 fRemains are Shipped,If Other than Above a Address Q to a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/01/2023 Registrar of Vital Statistics Caroline W idegarde Barber(ECectronicalfySigned) (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: WDate of Disposition 9 Z—Z3 Place of Disposition p A)to �:A� C t ik 2 (address) W CC (section) (lot number) (grave number) SName of Sexton or Person in Charge o mis " W 114r►1r,,4 0CY c 2 (please print) alSignature ----" 4,1 Title ©Oemu 4-14 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20 s� Jv A4 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#