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Bordis, Corleen NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vita[Records Name First Middle Last Sex Corleen Bordis I Female Date of Death Age If Veteran of U.S.Armed Forces, 03/02/2020 66 Years War or Dates II.— Place of Death Hospital,Institution or Z City,Town or Village Wilton Town Street Address 2402 Heritage Way,Wilton Town,New York 12831 Wannerof Death W M © Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title Todd Duthaler DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Gansevoort 4569 7 Burial Date Cemetery,Crematory or Facility Name 03/06/2020 Pine View Crematorium Entombment Address FRICremation Queensbury Town,New York 11 Donation zRemoval Date Place Removed and/or and/or Held F-N Hold Address O d Date Point of (n ❑Transportation p by Common Shipment 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 or to Whom f.- Remains are Shipped,If Other than Above 2 Address tr W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/05/2020 Registrar of Vital Statistics Susan BaCdwin(ECectronicaCCySigned) /signature) District Number 4569 Place Gansevoort, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 3 II 2A Place of Disposition L InAv t� W 2 (address) W Cl) a: (section/ (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pr ises f. L Z (p ase print) W Signature Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) ._1 _ °f41 �. :., Receipt Human remains of delivered on , 20 One View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#