Close, Joyce NEW YOR"STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
- Joyce Anne Close Female
Date of Death Age If Veteran of U.S. Armed Forces,
Ws:f February 6, 2011 72 War or Dates
-' Place of Death Hospital, Institution or
_' City, Town or Village Fort Edward Street Address FORT HUDSON HEALTH CARE FAC.
Manner of Death J Natural Cause ❑ Accident I I Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Philip J Gara Jr. MD,
Address
327 Broadway Fort Edward, NY 12828
Death Certificate Filed District Number Register Number
h City, Town or Village ,17,,55 7
®Burial Date Cemetery or Crematory
February 9, 2011 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold Pine View Cemetery
Date Point of
nTransportation Shipment
by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Zif Name of Funeral Home Carleton Funeral Home, Inc. 00276
Address
' Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
4 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is he eb granted to dispose of the human ins described a o as i icated.
.4 Date Issue ��� Registrar of Vital Statisti -di
--- (signature
ki,t� District Numb 5 Place d/'") "�I'1/ --- 6t1
_, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 02/09/2011 Place of Disposition Quaker Rd. Queensbury,NY 12804
(address)
Nelson Goss 410 Sec. 22 4
L?Section) (lot number) (grave number)
Name of Sexton or Pers ' Charge of PremisesMichael Genier
(please print)
Signature)\"{) = ti,.eAAMi`' Title
Superintendent
(over)
DOH-1555 (02/2004)