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Wiedl, Laura F NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Middle Last Sex Laura Parsons Wiedl Female Date of Death Age If Veteran of U.S. Armed Forces, March 31, 1994 29 War or Dates I-.:::::.: ........:..:..............::............:.:.....:...... Z W Place of Death Hospital, Institution or iga9?(Town)irAlillige Kingsbury Street Address 20 9th Aye, Kingsbury © Manner of Death W ❑ Natural Cause El Accident IllHomicide ❑ Suicide 0 Undetermined ❑ pending Circumstances Investigation la Medical Certifier Name...::.::. ................ .:.:.::.: Title © Dr. Barbara Wolf Coroner ' s Physician .....:.:............ Address Albany Medical Center, Albany, NY Death Certificate Filed District Number Register Number og }k TownROMk/L{ Kingsbury 5762 X Date Cemetery or Crematory ®Bunal April 7 1994 Pine View Cemetery Cremation Address In of Queensbury, NY z Date Place Removed O 0 Removal and/or Held I—' and/or Hold .::::.....::...............:..: ............... Address O;:..::. ........ :.:...........:......... n. Date . Point of co Ei Transportation by Ca Common Carrier Shipment Destination Disinterment Date Cemetery Address � Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Firm Carleton Funeral Home Inc. 00310 Address P.O. Box 67, 68 Main St., Hudson Falls, N.Y. 12839 t- Name of Funeral Firm Making Disposition or to Whom :2 Remains are Shipped, If Other than Above ....Address u a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued April 6, 1994 Registrar of Vital Statisticsz>, F e in EGG (signature) District Number 5762 Place Town of Kingsbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- W Date of Disposition 4/8/94 Place of Disposition Pine View Cemetery 2 (address) W< Mohican 87—C 1 CC (section) (lot number) (grave number) O p' Name of Sexton or Person in Charge of Premises Rodney Moshe r Z (please print) Signature Title Sput• DOH-1555 (10/89) p. 1 of 2 VS-61