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Levack, Catherine Ann .1„..F, NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Catherine Ann Levack Female Date of Death Age If Veteran of U.S.Armed Forces, 12/11/2023 94 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital ip Manner of Death ❑X Natural Cause Accident Homicide 0Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title O Abigail Macomber PA 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 583 Burial Date Cemetery,Crematory or Facility Name 12/14/2023 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 a Date Point of tlfTransportation S by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Li 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 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/13/2023 Registrar of Vital Statistics Megan Wain(ECectronicafTy Signed) (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: WDate of Disposition I"L4 1t 1� Place of Disposition g:.itik C ►1►�Y _ 2 (address) W CC (section) (lot number) (grave number) gName of Sexton or Person in Charge of Pr ises ��— ({: Z � ( ease print/ C W SignatureTitle �/�llll� ("L DOH-1555(07/18)p 1 of 2 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#