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Fee, Kathleen J NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathleen J.Fee Female Date of Death Age If Veteran of U.S.Armed Forces, 12/28/2023 68 Years War or Dates 1- Place of Death Hospital,Institution or City,Town or Village Queensbury Town Street Address 615 New York 149 Route,Queensbury Town,New York 12804 pManner of Death ❑X Natural Cause Accident 0Homicide Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title C3 Lynn Keil Coroner Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 194 Burial Date Cemetery,Crematory or Facility Name 12/29/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation g❑Removal Date Place Removed and/or and/or Held H Hold Address to 0 O. Date Point of U) Transportation Shipment Q by Common Carrier Destination 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 j— Remains are Shipped,If Other than Above 2 Address C W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/29/2023 Registrar of Vital Statistics CarolineWillegarde Barber(Electronically 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: WDate of Disposition 112.1 2I Place of Disposition FT�‘tlY60 CP+i 14 tt/.� 2 (address) W NIE (section) (lot number) (grave number) SName of Sexton or Person in Charge 2 ises ft / (pleaprint) -7-�,n W . ( Title '/1uq ► i` Signature DOH-1555(07/18)p 1 of 2 017802 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#