Sawyer, Christine NEW YORK STATE DEPARTMENT OF HEALTH 14431
Vital Records Section , Burial - Transit Permit
N. Name First Middle Last Sex
ill Christine Sawyer Female
Date of Death Age If Veteran of U.S. Armed Forces,
I- October 8, 2006 65 War or Dates IgS9-146!
z Place of Death Hospital, Institution or
W City, Town, or Village Queensbury Street AddressResidence
G Manner of Death X❑ Natural Cause ❑ Accident ❑ Homicide ❑Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
U Medical Certifier Name Title
W MARK HOFFMAN MD
CI Address
420 Glen St., Glens Falls, NY 12801
Death Certificate Filed DtNur�pre„r Register Number
�Q '
City, Town or Village Queensbury S f C)3
Date Cemetery or Crematory
E Burial October 10. 2006 Pine View Crematorium
Address
❑X Cremation Quaker Road Oueensburv, NY 12804-
Date Place Removed
4 ❑ Removal and/or Held
r and/or Address
Hold
11) Date Point of
4 ❑Transportation Shipment
a. by Common Destination
IA Carrier
Date Cemetery Address
O 0 Disinterment
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00283
Address
H 68 Main St., P. O. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
fe Remains are Shipped, If Other than Above ,
aAddress
Permission is h reby ranted to dispose of the human re a'ns described above as indicated.
Date Issued 10116 Registrar of Vital Statistics Q ,�t, r,
...___,
(signature)
District NumbercLo c fl Place Queensbury,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition io/'i w L Place of Disposition en,vu-+' Crtrsed tar!i+A,
W (address)
Or
O it (section) , (lot number) (grave number)
Name of Sexton or Person in Charge of Premises L. h r,S Ceinneti—
Z (please print)
W �/^ `
Signature ("'""'," Lif-WZ&' Title etc rr4tvr-