Labourr, Marion t NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
rvf Marion Elizabeth Labourr Female
,, Date of Death Age If Veteran of U.S. Armed Forces,
September 18, 2017 101 War or Dates
Place of Death Hospital, Institution or
w City, Town or Village Hudson Falls Street Address 17 North Oak Street
Ct Manner of Death Fri Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
ILL
t, Circumstances Investigation
Medical Certifier Name Title
Philip J Gara Jr. MD,
Address
327 Broadway Fort Edward, NY 12828
K Death Certificate Filed District Number Register Number
i City, Town or Village ,S--7,).,6 , ,
®Burial Date Cemetery or Crematory
September 25, 2017 Pine View Cemetery
❑EntombmentVA Address
-., ❑Cremation Quaker Rd. Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
p Hold Pine View Cemetery
Date Point of
t ❑Transportation Shipment
Co, by Common Destination
:.'- Carrier
❑ Disinterment Date Cemetery Address
3 ❑ 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
s z= Name of Funeral Firm Making Disposition or to Whom
i Remains are Shipped, If Other than Above
Address
Z.
Permission is hereby granted to dispose of the human remains described above as indicated.
ip Date Issued q /a-,/ / -2 Registrar of Vital Statistics __ (� . ,_
,L;,,,,
(signature)
District Number j-7,1_4 Place (/i I O4 tau Jc1 AS
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
u Date of Disposition 09/25/2017 Place of Disposition Quaker Rd. Queensbury,NY 12804
(address)
W
CO-
14 (section) (lot number) (grave number)
r Name of Sexton or Person in Charge of Premises
,z (please print)
LU Signature Title
(over)
DOH-1555 (02/2004)