Dunlavey, Lilian NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lillian Ruth DunLavey Female
� Date of Death Age If Veteran of U.S. Armed Forces,
June 1, 2012 83 War or Dates
Place of Death Hospital, Institution or
ill City, Town or Village Glens Falls Street Address Glens Falls Hospital
WManner of Death Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
C.) Circumstances Investigation
WW Medical Certifier Name Title
Mathew Varughese, MD Dr.
Address
Glens Falls Hospital Hudson Falls, NY 12839
Death Certificate Filed District Number Register Number
City, Town or Village 5601 2 c Q
®Burial Date Cemetery or Crematory
June 6, 2012 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
o? and/or Address
E Hold Pine View Cemetery
CO Date Point of
eL❑ Transportation Shipment
CO by Common Destination
C1 Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
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
rt
w
1 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 6 / t-j l t . Registrar of Vital Statistics Q&j „�,
(signature)
District Number 5601 Place G s c.e l t s / N
�. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 6/6/1 2 Place of Disposition Pine View Cemetery
2 (address)
W' Hudson Sec. 2 8 B 2
ft (section)
(lot number) (grave number)
c Name of Sexton or Perso in Charge of Premises Michael Genier
2 (please print)
W' Signature �'"`^-"- Title Superintendent
(over)
DOH-1555 (02/2004)