Gilman, Carla NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carla Joan Gilman Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 25, 2014 74 War or Dates
Place of Death Hospital, Institution or
uj City, Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W. Medical Certifier Name Title
L - Michael Miles, M.D
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number Register b
City, Town or Village ''/Q /J
®Burial Date Cemetery or Crematory
August 30, 2014 Pine View Cemetery
❑Entombment Address
LJCremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
z Removal and/or Held
and/or Address
i Hold Pine View Cemetery
0'- Date ' Point of
r1 ❑Transportation Shipment
by Common Destination
Carrier
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
Address
w
d Permission is he eby ranted to dispose of the human re ains des ' ed above s indicated
Date Issued �� UJ Registrar of Vital Statistics Q /Uc2
j---, • ature)
District Number .57ot ( Place I
(--/?X
F' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 08/30/2014 Place of Disposition Quaker Rd. Queensbury,NY 12804
(address)
W Famly Plot Hudson Sec. 1 10 A 5
C4 (section) (lot number) (grave number)
ci Name of Se ton or Person in Charge of Premises Connie L. Goedert
(please print)
W `\ Superintendent
Signature ° _] 0 Title
(over)
DOH-1555 (02/2004)