Dufour, Blanche R _3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Blanche Catherine Dufour Female
}, Date of Death Age If Veteran of U.S.Armed Forces,
May 26,2018 92 War or Dates
P Place of Death Hospital, Institution or
ZCity, Town or Village Greenwich Street Address
ct Manner of Death®Natural Cause Accident 0 Homicide Suicide Undetermined Pending
Circumstances Investigation_
Medical Certifier Name Title
Ryan Donnelly DO
Address
161 Carey Rd,Bld 2,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City,Town or Village 51/51 6 1
®Burial Date Cemetery or Crematory
June 01,2018 Pine View Cemetery
.,[]Entombment Address
['Cremation Quaker Road,Queensbury,NY
Date Place Removed
gri Removal and/or Held
F
and/or Address
Hold
Date Point of
iii L. Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
sReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home,Inc. 00281
Address
68 Main Street,Hudson Falls,NY 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
t
Permission is hereby granted to dispose of the human remains described above as indicated.
` Date Issued S--30 •a.o I g Registrar of Vital Statistics '1`-0D-{ --��c e Q cal
(signature)
District Number CVC-1 Place QU e en c rjt/l
F I certify that the remains of the decedent identified above wer disposed of in accordance with this permit on:
WDate of Disposition 6/1 /20118ace of Disposition Pine View Cemetery Queensbury
2 (address)
Mohican 51 -A 2
(section) (lot number) (grave number)
Name of S- on or Person in Charge of Premises Connie Goedert
(please print)
W,, Signatu -` _tit 4 A Title Cemetery Superintendent
(over)
DOH-1555(02/2004)