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Sova, Dawn Beverly NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Dawn Beverly Sova Female Date of Death Age If Veteran of U.S.Armed Forces, 11/25/2019 70 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause Accident Q Homicide Suicide ❑Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 509 ❑Burial Date Cemetery,Crematory or Facility Name 11/27/2019 Pine View Crematorium Entombment Address el Cremation Lake George Village,New York ❑Donation OZ ❑Removal Date Place Removed and/or and/or Held ~ Hold Address O IZ Date Point of N ❑Transportation Shipment p by Common 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 Street,P.O.Box 67, Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom II.— Remains are Shipped,If Otherthan Above 2 Address cc W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/27/2019 Registrar of Vital Statistics R96ertAndrew Curtis(ECectronicaCCySiyned) (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: H pp //11 Z Date of Disposition -LI I jj Place of Disposition 'Gk v ( dry W (address) 2 W N (section) (lot number (grave number/ 0 Name of Sexton or Person in Charge of Premises A I Z l lease print W r Signature Title c. DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 31 Receipt Human remains of t `' 'f�- delivered on 20 ?l' i Pink View Cemetery Representing the funeral home named 9p burial,permit Official Funeral Directors Reg.or License#