Wright, Adalyn NEW YORK STATE DEPARTMENT OF HEALTH' �� l
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Adalyn Marie Wright Female
Date of Death Age If Veteran of U.S. Armed Forces,
, : July 17, 2018 0 War or Dates
Place of Death Hospital, Institution or
Ci
u; ty, Town or Village Glens Falls Street Address Glens Falls Hospital
W.E Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
0Circumstances Investigation
LLI LU Medical Certifier Name Title
Danielle L Goertzen, M.D. Dr.
Address
101 Ridge Street Glens Falls, NY 12801
h Certificate Filed District Number Register Number
i own or Village (. iN,? E l 1, 564/
❑Burial Date Cemetery or Crematory
July 19, 2018 Pine Vew Crematorium
.`',❑Entombment Address
°R ®Cremation Queensbury,NY 12804
,' Date Place Removed
z ❑ Removal and/or Held
j and/or Address
I- Hold
N Date Point of
od0 Transportation Shipment
CO by Common Destination
0 Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
'. Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
2 Address
W
C' Permission is hereby granted to dispose of the human remains descr' e a vv s i ted.
Date Issued . i7� Zp<8.- Registrar of Vital Statistics
(signature)
District Number 5-46/ Place ..4. g A-A, ,v y
. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
JJ Date of Disposition 07/19/2018 Place of Disposition Queensbury,NY 12804
(address)
W
IX (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises Tel rite.,y' S L;fed S
Z (please print)
W Signature ^' Title ,rei /r
(over)
DOH-1555 (02/2004)