Zambrano, Rosario NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
0� Name First Middle u Last Sex
•
1� Rosario Maria Zambrano Female
Date of Death Age If Veteran of U.S. Armed Forces,
I- June 10, 2006 97 War or Dates
Z 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 ❑ Undetermined ❑ Pending
W Circumstances Investigation
0 Medical Certifier Name Title
W DANIEL WAY_MD
a Address
North Creek Health Ctr, Warrensburg, NY
t+` Death Certificate Filed District Number Register Number
t City, Town or Village Glens Falls
Date Cemetery or Crematory
❑ Burial June 12, 2006 Pine View Crematorium
Address
Z ❑X Cremation Ouaker Road OueensburV, NY 12804-
Date Place Removed
0 ❑ Removal and/or Held
- and/or Address
- Hold
11) Date Point of
0 ❑Transportation Shipment
11 by Common Destination
th Carrier
Date Cemetery Address
a ❑ 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
X Remains are Shipped, If Other than Above
W Address
O.
Permission is here y g anted to dispose of the human re 'ns described ve as indi ated
Date Issued o7 6_ Registrar of Vital Statistics L
signature)
District Number � '0/ Place Glens Falls,New Y k
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition b-/3-O jt Place of Disposition / add ess ���i�L 4-�K, 0
W
0
rr (s tion) lot numb r) (grave number)
O Name of Sexton or Person in Charge of Premises (SIS V
W
Signature( e (please pri Title n
(l RE-. L4,- 79
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