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Gratton, June E t NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex June Eleanor Grafton Female Date of Death Age If Veteran of U.S. Armed Forces, 09/08/2017 93 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitati Q Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending � Circumstances Investigation w Medical Certifier Name Title O Gwendolyn Morris-Dickinson PA rvl Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 480 :'NBurial Date Cemetery or Crematory 09/16/2017 Pine View Cemetery 4 ❑Entombment Address ❑Cremation Queensbury Town, New York Date Place Removed Z❑Removal and/or Held F and/or Address CP Hold E Date Point of CO ❑Transportation Shipment G 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 68 Main Stpo Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped, If Other than Above g Address g Permission is hereby granted to dispose of the human remains described above as indicated. Pl- Date Issued 09/11/2017 Registrar of Vital Statistics /t96ertACurtis ECectronica fly Signed. (signature) ,` District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition Place of Disposition 2 (address) CO (section) (lot number) (grave number) • Name of Sexton or Person in Charge of Premises (please print) Signature Title (over) DOH-1555 (02/2004)