Hartung, Charlotte NEW YORK STATE DEPARTMENT OF HEALTF. ' 5 ( L
.
Vital Records Section �,, Burial - Transit Permit
Name First Middle Last Sex
Charlotte R. Hartung Female
Date of Death Age If Veteran of U.S. Armed Forces,
F December 18, 2006 90 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 x❑ Natural Cause ❑ Accident ❑ Homicide ❑Suicide n Undetermined ❑ Pending
W Circumstances Investigation
ti Medical Certifier Name Title
W Dr. Jennifer Stratton, M.D. Dr.
0 Address
14, Manor Drive, Queensbury, NY 12804
Death Certificate Filed District Number �c,® / Register Number
r
City, Town or Village Glens Falls
Date Cemetery or Crematory
❑ Burial December 26, 2006 PINE VIEW CREMATORIUM
Address
n Cremation
Tn of Oueensburv, NY 12804
Date Place Removed
0 ❑ Removal and/or Held
- and/or Address
Hold
0 Date Point of
0 ❑Transportation Shipment
C. by Common Destination
di Carrier
Date Cemetery Address
a ❑ Disinterment
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00283
Address
F 68 Main St., P. O. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
ix Remains are Shipped, If Other than Above
W Address
0.
Permission is hereby ranted to dispose of the human remains descri d above indi
Date Issued /2 /?/06 Registrar of Vital Statistics i k
(signature)
District Number ,5 60/ 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:
Z
w Date of Disposition la/fl/o(, Place of Disposition 17i q eJ, !(.%) Ct:Th4fi c r I uti
m (address)
v)
IY (section) (lonumber) (grave number)
a Name of Sexton or Person incharge of Premises £A r; t -ell n4t4
Z 2 ' (please print)
w Signature C/
-- Title C'eml w fur