Spear, Kathleen 4 57.E
NEW YORK STATE DEPARTMENT OF HEALTH. =Vital Records Section Burial - Transit Permit
,�:_ Name First Middle - Last Sex
Kathleen Marie Spear Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 12,2018 59 War or Dates
r— Place of Death Hospital, Institution or
6 City, Town or Village Kingsbury Street Address 18 Blenor Ave
Q Manner of Death®Natural Cause 0 Accident 0 Homicide 0 Suicide piUndetermined El Pending
W Circumstances Investigation
W; Medical Certifier Name Title
C3 Dr.Stoutenburg
Address
102 Park St.,Glens Falls,NY
is Death Certificate Filed .District Number Register Number
7 City, Town or Village 57 6 d2, Q G
OBurial Date Cemetery or Crematory
July 15,2018 Pine View Crematorium
1 ❑Entombment Address
®Cremation
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
N
HOId
Q Date Point of
Q Transportation Shipment
a by Common Destination
Carrier
0 Disinterment Date Cemetery Address
Al
Q Reinterment Date Cemetery Addres •
x' Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home,Inc. 00281
Address
68 Main Street,Hudson Falls,NY 12839
Name of Funeral Firm Making Disposition or to Whom
F_ Remains are Shipped, If Other than Above
Address
C
W
C" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 7- /3 `AG/b Registrar of Vital Statistics � --.-R...2,e c 3,
�- �--
(signature)
District Numbers 76 Place l ,
I certifythe remains of decedent identified bove wer4of
F that the �dis os in accordance with this permit on:
Z'
WW: Date of Disposition '71114 Place of Disposition .,lil.. �'r,,, o,r
W
(address)
GO
C4'
(section) (lot nu er) � (grave number)
pName of Sexton or Person in Charge of.Premises I fr„f+p1_ 8 V%Lr
Z' (please print)
W Signature /A Q' Title AZPIAIIA.,
(over)
DOH-1555 (02/2004)