Carey, Margaret z
NEW YORK STATE DEPARTMENT OF HEALTH , #Y1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Margaret Ruth Carey Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/24/2017 96 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Philip Gara MD
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edward 5755 38
❑Burial Date Cemetery or Crematory
08/25/2017 Pine View Crematory
['Entombment Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/25/2017 Registrar of Vital Statistics Aimee Alahoney EtectmnicaaySigned-
(signature)
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition $/i/q Place of Disposition ,?.,�,„/ r,.m,Vicw
(address)
(section) /1 (lot number) (grave number)
�
Name of Sexton or Person in Charge of Premiss /. ii1 ,/^ PvAlCt
(pl ase print)
Signature 11 Title (R r/9
(over)
DOH-1555 (02/2004)