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Holycross, Pamela N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Pamela Holycross Female Date of Death Age If Veteran of U.S.Armed Forces, 11/23/2023 64 Years War or Dates i_ Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death X❑Natural Cause Accident ❑Homicide Suicide Undetermined Pending V Circumstances Investigation ILI Medical Certifier Name Title 0 Marcille Labban MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 556 Burial Date Cemetery,Crematory or Facility Name E11/29/2023 Pine View Crematory Entombment Address ©Cremation Queensbury,New York Donation ISTIRemoval Date Place Removed and/or and/or Held F- Hold Address N 0 O. Date Point of (I)ETransportation ZS by Common Shipment Carrier Destination O Disinterment Date Cemetery Address 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 F Remains are Shipped,If Other than Above 't' Address C W G. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/29/2023 Registrar of Vital Statistics Ilegan Nolin(E(ectronica1TySigned) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 1 Z I I I 7,3 Place of Disposition rz•rEvi 6.J (04 41AlN --•- 2 (address) LU Q (section) /J _(tot number) (grave number) G /Name of Sexton or Person in Charge. Pr mises (/�a 'v"4 li Z Tease print)W / Signature Title ` ''m'1T q DOH-1555(07/18)p 1 of 2 1 .7_� 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#