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Lapine, Margaret Beakbane NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margaret Beakbane Lapine Female Date of Death Age If Veteran of U.S.Armed Forces, 03/10/2020 98 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc p Manner of Death ©Natural Cause ❑Accident Homicide Suicide Undetermined Pending VCircumstances Investigation WW Medical Certifier Name Title Michael Miles MD Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 21 Burial Date Cemetery,Crematory or Facility Name 03/12/2020 Pine View Crematorium Entombment Address RCremation Queensbury Town,New York ❑Donation OZ Removal Date Place Removed and/or and/or Held H Hold Address O d Date Point of (A ❑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 Iz W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/12/2020 Registrar of Vital Statistics Aimee Mahoney(ECectronicalTy Signed) /signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t— Z Date of Disposition 3 l� 7d Place of Disposition 2 (address) W Cl) cc (section/ lot number/ /grave number/ 0 Name of Sexton or Person in Charge Premises t t �— ��� Z (plea print/ W Signature Title DOH-1555(07/18)p 1 of 2 I Public Health Law Sec. 4145(2b) 113 11,"-)1 Receipt Human remains of "&Kered on 4 20t -''Pine Vfew Cemetery Representing the funeral home named on buri4permit Official Funeral Directors Reg.or License#-L�-