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Williams. Carol A
NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Carol A.Williams Female Date of Death Age If Veteran of U.S.Armed Forces, 01/19/2024 75 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death El Natural Cause Accident Homicide El Suicide Undetermined ri Pending W (� Circumstances Investigation LU G Medical Certifier Name Title Shahid Ahmed 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 42 Burial Date Cemetery,Crematory or Facility Name 01/23/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ISRemoval Date Place Removed F and/or and/or Held Hold Address N Transportation Date Point of by Common Shipment Carrier Destination EiDisinterment 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 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 01/23/2024 Registrar of Vital Statistics Megan Nofin(ECectronicaffy 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: W Date of Disposition I)241 I2'1 Place of Disposition a'Nfv.J C M�yrA2�cs�^ 2 (address) W CC (section) �'/► (lot number) (grave number) GName of Sexton or Person in Cha remises 1" �"`� Z (pl#ase print) p W Signature Title 4/Woe DOH-1555(07/18)p 1 of 2 1 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#