Mabb, Dona NEW
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
T. Name First Middle Last Sex
Dona Lee Mabb Female
Date of Death Age If Veteran of U.S. Armed Forces,
tiql
February 25, 2017 78 War or Dates
1" Place ath Hospital, Institution or
City, ow or Village Queensbury Street Address 477 Upper Sherman Ave.
Manner of Death X Natural Cause 0 Accident El Homicide 1=i Suicide ri Undetermined El Pending
Ilk
Circumstances Investigation
W Medical Certifier Name Title
Eric Goe, Dr.
'�� Address
65 Elm Street Glens Falls, NY 12801
Death Ce-i lcate Filed District Number egister Number
City„ Town.or Village G'tA f,' ,>'_, 'Fv -' ' .(0 T) 1
:®Burial Date Cemetery or Crematory
March 6, 2017 WEST GLENS FALLS CEMETERY
•,❑Entombment Address
&, Cremation Main St. Queensbury,NY 12804
Date Place Removed
=z,❑ Removal and/or Held
and/or Address
,., Hold WEST GLENS FALLS
Date Point of CEMETERY
,"• ❑Transportation Shipment
ati;; by Common Destination
Carrier
i" Date Cemetery Address
❑ Disinterment
❑ Reinterment Date Cemetery Address
O Permit Issued to Registration Number
-740
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
Remains are Shipped, If Other than Above
Address
Permission is hereby ranted to dispose of the human re lens descri d as indicated.
�� �Re istrar of Vital Statistics �'�
Date Issued c� g n
(signature)
`• District NumbeC2pifl Place 1 0 t .5._ ,1 o f
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 03/06/2017 Place of Disposition Main St. Queensbury,NY 12804
dress)
tu 1Wa.s t C,Ees -
(s n) (lot number) (grave number)
Name of '_- in or Perso harge of - - ises__ /2-4-.r @ _ - 63_ ^ i
i dw, _ (pleas print)
W Signatu L1 . agar iW1 Titl
ir
(over)
DOH-1555 (02/2004)