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Stockman,Janet Lee NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Janet Lee Stockman Female Date of Death Age If Veteran of U.S.Armed Forces, 04/24/2020 77 Years War or Dates F' Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 1260'West Mountian Road Apt.115,Queensbury Town,New York 12804 Lu p Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title 93 Anne Evans DO Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 78 ❑Burial Date Cemetery,Crematory or Facility Name 04/27/2020 Pine View Crematorium Entombment Address Cremation Queensbury Town,New York Donation z Date Place Removed C Removal and/or and/or Held H usHold Address O (L Date Point of V) 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 orto Whom 1- Remains are Shipped,If Other than Above Address IX W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/24/2020 Registrar of Vital Statistics Caroline Mi[degarde Barber(ECectronicalTy Signed (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disp s d of in ccordan with this permit on: // /a/fg,6 q W Date of Disposition Place of Disposition ►h¢ ( 2/&4�4 (address) W N (s�jion/ (lot number) (grave number) Name of Sexton or Person' Ch a of Premises Wi (p/ease print/ Signature Title DOH-1555(07/18)p 1 of Public Health Law Sec. 4145(2b) n. 13F,45 Receipt Human remains of a`1 delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#