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Deeb, Karen A Fulton LF tf5gs- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last ' Sex Karen A.Fulton Deeb Female Date of Death Age If Veteran of U.S.Armed Forces, 12/04/2023 75 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 354 Dixon Road, Queensbury Town, New York 12804 W Pending W Manner of Death El NaturalCause Accident III HomicideSuicide Undetermined Circumstances Investigation W Medical Certifier Name Title CI Adrianna Earl Other Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 184 Burial Date Cemetery,Crematory or Facility Name 12/07/2023 Pine View Crematory Entombment — Address ©Cremation Queensbury Town,New York Donation O❑Removal Date Place Removed c and/or and/or Held N Hold Address 0 O. Date Point of U)n Transportation Shipment b by Common Carrier Destination ODisinterment Date Cemetery Address El 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 H Remains are Shipped,If Other than Above a Address Q W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/07/2023 Registrar of Vital Statistics Caroline Jfi(fegarde Barber(ECectronicaffy 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: IH Z Date of Disposition jy1q ft:3 Place of Disposition ' idJ v€:1 ( 4')qr02Pu'IIJ 2 (address) W CCCC (section) i (lot number (grave number) 8 Name of Sexton or Person in Charge of Premises r L_ ---- Oil Atli Z /p/ase print/ W Signature Cam" Title 6124 474 Iv!t DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of �_; delivered on , 20 Pine Vie etery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 011101k Town of Queensbury Certification of Cremation f NY- Pine View Cemetery and Crematory This certifies that the remains of: Karen A Fulton Deeb were cremated on December , 8 20 23 at the Pine View (Month) (Day) Crematorium, Queensbury, New York, and these are the cremated remains of said body. Date of Death December , 4 20 23 Age 75 (Month) (Day) Funeral Home Singleton Sullivan Potter Registered No. 985 (Authorized Signature) r� DEEB L}-� Owner Karen & Joseph neeb Address Plot 354 Dixon Rd Queensbury, NY 12804 Algonquin Phone # Lot # 518-793-5613 SEc B 1 -13 Deed # Date 4300 12.9.21 Cost Foundation Y - N $350.00 Location North-Fulton South-Vacant East-Vacant West-Vacant Remarks I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE PINE VIEW CEMETERY: SIGNATURE: 2 DATE: /2 '°I ' ?O21 AG SIGNATURE: ��— DATE: / �sf' 2oa/ Record of Interments 1 6 2 �o is • 4tc---e.x-\ 1 3 )-a - 13- a� 3 8 4 9 5 10 U/ v. (1' W � n DEER (LF NAME Karen A. Fulton Deeb Age: 75 Lot Owner: Karen & Joseph Deeb Lot# Algonquin Sec. B 1 #1 3 Grave# 2 Case: Urn Died: 1 2.4.2 3 Interred: 1 2. 1 3.2 3 Funeral Home: Singleton Sullivan Potter Cemetery: Pine View