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French, Lena NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Lena May French Female fk Date of Death Age If Veteran of U.S. Armed Forces, 09/17/2017 91 Years War or Dates i- Place of Death Hospital, Institution or City, Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre Manner of Death©Natural Cause El Accident ri Homicide Ej Suicide Undetermined Pending ILICircumstances Investigation w Medical Certifier Name Title Q Roslyn Socolof MD Address 152 Sherman Ave,Queensbury Town,New York 12801 %a Death Certificate Filed District Number Register Number City, Town or Village Queensbury 5657 120 Burial Date Cemetery or Crematory 09/22/2017 St.Alphonsus Cemetery ❑Entombment Address ❑Cremation Queensbury Town, New York Date Place Removed Z Removal and/or Held 0❑and/or Address H Hold O 0 Date Point of NQ Transportation Shipment by Common Destination 3 Carrier . Q Disinterment Date Cemetery Address �F Q Reinterment Date Cemetery Address Permit Issued to Registration Number ,_ Name of Funeral Home Carleton Funeral Home Inc 00281 g': Address 68 Main Stpo Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom I- Remains are Shipped, If Other than Above Address tii a, Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/18/2017 Registrar of Vital Statistics carol ne2fBarier ctronicaaySigned (signature) ''-- District Number 5657 Place Queensbury, New York Ir-' I certify that the remains f t decedent identified above were disposed of in accordance ith this permit on: W Date of Disposition `� L / "/ Place of Disposition J�. / - u 5 tAtfeA PI `� (a dress) !! 0) ce (section) marL er) (grave number) Name of Sexton or rson in Charge of Premisesnu t'L`' z' (please print) 4,1 Signature Title (over) DOH-1555(0212004)