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Geroux, Janet NEW YORK STATE DEPARTMENT OFHEALTH Burial - Transit Permit Bureau of VitaL Records Name First Middle Last Sex Janet D Geroux Female Date of Death Age If Veteran of U.S.Armed Forces, 10/31/2019 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Undetermined Pending W ©Natural Cause Accident Homicide Suicide W Circumstances Investigation U Title W Medical Certifier Name William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 470 ❑Burial Date Cemetery,Crematory or Facility Name 11/04/2019 Pine View Crematorium Entombment Address Cremation Queensbury Town,New York Donation Z ❑Removal Date Place Removed and/or and/or Held f— Hold Address N dDate Point of (A ❑Transportation Shi ment p by Common p Carrier Destination 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 Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/01/2019 Registrar of Vital Statistics q�g6ertAnfrew Curtis(ECectronicaCCySiyned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were dispose in accor ance with this ermit on: f.. _ . Z Date of Disposition )0[3112,01q Place of Disposition l✓L2 / W (address) W (1) /section) #lot number) (grave number) cc Name of Sexton or Person in Charge f Premise (please print) Z IL'�6' W Signature Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) -` 0 4.1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#