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Sitterly, Helen M. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Helen M Sitterly Female Date of Death Age If Veteran of U.S.Armed Forces, 05/04/2020 74 Years War or Dates II. Place of Death Hospital,Institution or W' City,Town or Village Queensbury Town Street Address 35 Evergreen Lane Apt 211,Queensbury Town,New York 12804 p Mannerof Death ©Natural Cause EJAccident Homicide Suicide Undetermined Pending VCircumstances Investigation W Medical Certifier Name Title Antonio Izzo NP Address 340A Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 94 Burial Date Cemetery,Crematory or Facility Name 05/06/2020 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0 ❑Removal Date Place Removed and/or and/or Held N Hold Address O a' 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 Remains are Shipped,If Other than Above 2 Address cc W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/05/2020 Registrar of Vital Statistics CarohnexlfegardeBarber(ECectronicalCySigned) /signature/ District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W' Date of Disposition sod 20 Place of Disposition U /address/ W /section/ (lot number/ (grave number/ cc O Name of Sexton or Persortiii Charge of Premises ^1 (/ /pt e print/ W Signature C/ Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(l b) 0 7 2 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#