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Alverson, Georgia A
# 2 o NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Georgia A.Alverson Female Date of Death Age If Veteran of US.Armed Forces, 03/04/2024 78 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital O Manner of Death 1=1 Natural Cause Accident El Homicide 0 Suicide Erndetermined Pending IIJ ircumstances Investigation W Medical Certifier Name Title CI Bo Li MD Address 100 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 130 Burial Date Cemetery,Crematory or Facility Name 03/06/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 6❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of to Transportation Shipment b by Common Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address 11 Reinterment 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 1.. Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/05/2024 Registrar of Vital Statistics 9tfegan Noll?!(ECectronica1Ty 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: Z Date of Disposition 3 IS 121 Place of Dispositionr724,4,..u. CPS NVU4+-. ILI 2 (address) W N (section) (lot number) (grave number) Q gt.• l if Name of Sexton or Person in Charge of P mises Z (p se print/ W Signature (.../(2 Title fY1� DOH-1555(07/18)pi 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#