Cooper, Anne NEW YORK STATE DEPARTMENT OF HEALTH 2S-^Z
Vital Records Section M, Burial - Transit Permit
Name First Middle Last Sex
Anne Marie Cooper Female
` Date of Death Age If Veteran of U.S. Armed Forces,
I- May 28, 2006 75 War or Dates
2 Place of Death Hospital, Institution or •
W City, Town, or Village Glens Falls Street AddressGlens Falls Hospital
G Manner of Death 0 Natural Cause ID Accident u Homicide IDSuicide El Undetermined El Pending
W Circumstances Investigation
Medical Certifier Name Title
W MICHAEL CASTRO MD
0 Address
102 Park Street, Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5 I 2.LI L.-/
Date Cemetery or Crematory
❑ Burial May 31, 2006 Pine View Crematorium
Address
0 Cremation Quaker Road Queensbury, NY 12804-
Date Place Removed
0 0 Removal and/or Held
- and/or Address
Hold
0 Date Point of
0 El Transportation Shipment
D. by Common Destination
0 Carrier
- Date Cemetery Address
6 Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00284
Address
1_ 68 Main St., P. O. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
0: Remains are Shipped, If Other than Above
W Address
O.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 513 0/0 6 Registrar of Vital Statistics \Z\as/ --A CAAAA42.11A1 i,',
(signature)
District Number 5760 1 Place Glens Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ,
2
w Date of Disposition Z_/6 � Place of Disposition r �' "--i�+-,mac h-1--e U) •^mil.
(address)
N v t7 L> 6y (Q 4-1
t (section) (lot number) (grave number)
aName of Sexton or Person in Charge of Premises
2 (please print)
Signature 71e..„-!,( , Title C Rr.'.ys A tC, Q .