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O'Neill, Christine Fay N EW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Christine Fay O'Neill Female Date of Death Age--TIf Veteran of U.S.Armed IForces, 03/26/2020 68 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W U Circumstances Investigation ai Medical Certifier Name Title Stephen Perazzelli MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 143 Burial Date Cemetery,Crematory or Facility Name 03/30/2020 Pine View Crematorium Entombment Address RI Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held ~ Hold Address N O 4. Date Point of N Transportation p by Common Shipment Carrier Destination Disinterment 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 F. Remains are Shipped,If Other than Above Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/29/2020 Registrar of Vital Statistics cRg6ertAndrew Curtis(ECectronicaiTySiyneq) (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 � Z Date of Disposition 3 1.3j 20 Place of Disposition �w�.. Lu 2 /address/ W IM (section/ li t/ /lot r/numbe C rave number/ / Name of Sexton or Person in Charge of P7remises �"� L/.�+�j g Z / /p ase prin W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1, 013483 Receipt Human remains of L) !11<-` delivered on '` , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# �' � _