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Toohey, Marie Eleanor NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marie Eleanor Toohey Female Date of Death Age If Veteran of U.S.Armed Forces, 12/07/2019 91 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title Kenneth France MD Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 529 Burial Date Cemetery,Crematory or Facility Name 12/11/2019 Pine View Crematorium Entombment Address X❑Cremation Queensbury Town,New York ❑Donation z ❑Removal Date Place Removed and/or and/or Held F- Hold Address N O (L Date Point of Cl) Transportation Shipment p by Common Carrier Destination EjDisinterment Date Cemetery Address ElReinterment 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 or to Whom H Remains are Shipped,If Otherthan Above Address cc W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/10/2019 Registrar of Vital Statistics Wp6ertAndfrew Curtis(ECectronicaCCy Signed) (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: ! l+ Z Date of Disposition L I Place of Disposition M �./ W (address) 2 W to (section) ([W number/ (grave number) A6 0 Name of Sexton or Person in Charge of Premises lease print/ W Signature Title MI MI DO H-1555(07/18)p 1 of 2 t I I Public Health Law Sec. 4145(2b) 01314 8 I I i Receipt Human remains of delivered on , 20 I Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#" t