Mabb, Peggy NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
1 Name First Middle Last Sex
Peggy Louise Mabb Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 15, 2013 68 War or Dates
Place of Death Hospital, Institution or
at City, Town or Village Glens Falls Street Address Glens Falls Hospital
Ci Manner of Death Natural Cause L Accident I t Homicide I I Suicide n Undetermined � Pending
U.S i Circumstances Investigation
ill Medical Certifier Name Title
CI James North, M.D
Address
100 Broad St. Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village ��
®Burial Date Cemetery or Crematory
July 19, 2013 WEST GLENS FALLS CEMETERY
0 Entombment Address
'Cremation Main St. Queensbury,NY 12804
Date Place Removed
z Removal and/or Held
0 l-- and/or Address
},. Hold WEST GLENS FALLS
Date Point of CENIE n }<Y
o
i,„ C Transportation Shipment
0) by Common Destination
L Carrier
0 Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I-.-; Remains are Shipped, If Other than Above
2 Address
Ct
4U
Ci' Permission is hereby granted to dispose of the human remains desc d a ' ated.
Date Issued �'r,/.3 Registrar of Vital Statistics
��f'
_/� (signature)
District Number 560 Place / p1 `2—;/5, A /
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
uj Date of Disposition 7/1 9/1 3 Place of Disposition West Glens Falls Cemetery
2 (address)
LlY Mabb Family Plot
(section)
(lot number) (grave number)
0 Connie L. Goedert
Name of Se ..nor Person in Charge of Prep ises (please print)
W' Signature/ r . Z /r'.id�, Title Superintendent
r
(over)
DOH-1555 (02/2004) --