Browne, Mary NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section , ` '' , Burial - Transit Permit
Name First Middle Last Sex
Mary Elizabeth Browne Female
Date of Death Age If Veteran of U.S. Armed Forces,
F- February 4. 2006 88 War or Dates
2 Place of Death Hospital, Institution or
W City, Town, or Village Granville Street AddressINDIAN RIVER REHAB & HLTH CARE
0 Manner of Death E Natural Cause 0 Accident 0 Homicide n Suicide D Undetermined 0 Pending
W Circumstances Investigation
Medical Certifier Name Title
W Dr. Max Crossman, M.D. Dr.
Q Address
North St., Granville, NY 12832
x Death Certificate Filed District Number Register Number
City, Town or Village Granville
�
11 Date Cemetery or Crematory
I Burial February 7. 2006 Pine View Crematorium
Address
El Cremation Quaker Road Queensbury. NY 12804-
Date Place Removed
0 iii Removal and/or Held
- and/or Address
I' Hold
0 Date Point of
0 0 Transportation Shipment
d by Common Destination
0 Carrier
Date Cemetery Address
8 0 Disinterment
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00284
Address
1, 68 Main St., P. 0. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
a• Remains are Shipped, If Other than Above
W Address
0.
Permission is hh re y granted to dispose of the human rem ove as indicated.
Date Issued 0 ti (Q Registrar of Vital Statistics
(signature)
District Number �j7 2 Place Granville,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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w Date of Disposition �,-�'��0(# Place of Disposition /0 y Ti
g (address)
W
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t (section) (lot number) i (grave number)
0
0 Name of Sexton or Person in Charge of Premises &L�-jZ,L( (j.-R-vi,'
Z ' (please print)
W Signature ? ,,L�-1 -1- I Z
Title 1��,
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