Morrissey, Nancy L NEW YORK STATE DEPARTMENT OF HEALTH
,F Burial - Transit Permit
Bureau of Vital Records ,
Name First Middle Last Sex
Nancy L.Morrissey Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/06/2024 62 Years War or Dates
F- Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 16 Maple Drive,Queensbury Town,New York 12804
O Manner of Death ❑X Natural Cause Accident ❑Homicide ESuicide ❑Undetermined ri Pending
UJ
Circumstances Investigation
W Medical Certifier Name Title
a Aimee Mcmaster NP
Address
9 Carey Road,Queensbury Town,New York 12804 •
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 3
Burial Date Cemetery,Crematory or Facility Name
01/12/2024 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
ZRemoval Date Place Removed
F and/or and/or Held
M Hold Address
2 Date Point of
N Transportation
a by Common Shipment
Carrier Destination
ODisinterment 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
},, Remains are Shipped,If Other than Above
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Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/08/2024 Registrar of Vital Statistics Caroline JhWdegarde Barber(ECectronica(Cy 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:
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W Date of Disposition 1,^ l --a. 3,} Place of Disposition � 1 Q� ; U� � -� �;'uc��
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N ccsection) (lot number) (grave number)
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0 Name of Sexton or Perso in Charge of Pre ' �} nn 1 c- C�c�c ci` e -I-
(please print)
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W Signature Title -=>, i)�er i n -kJ ic)�fl/.-
DOH-1555(07/18)p 1 of 2
117417)
Public Health Law Sec. 4145(2b) -
Receipt
Human remains of delivered on , 20 -
•
Pixie View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
MORRISSEY
Owner
David Morrissey
Address Plot
16 Maple Dr. Oueenshnry, NY 12804 Erie
Phone # Lot #
518-260.0444 27F
Deed # Date
4424 1 . 12.24
Cost Foundation Y - N
$1 400.00
Location West-Road
North-Battiste
South-Vacant
East-Jones/MacCalman
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: re 2
DATE: )
SIGNATURE: DATE:
Record of Interments
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MORRISSEY
NAME Nancy L Morrissey Age: 62
Lot Owner: David Morrissey
Lot# Erie 27F Grave# 1
LF
Case: Concrete '
Died: 1 .6.2 4 Interred: 1 .1 2.2 4
Funeral Home: Singleton Sullivan Potter FH
Cemetery: Pine View