Sexton, Edna ti
NEW YORK STATE DEPARTMENT OF HEALTH
y4y
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edna Jean Sexton Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/09/2018 72 Years War or Dates
1- Place of Death Ht`trspital, Institution or
WCity, Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death RINatural Cause 0 Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
G Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 289
['Burial Date Cemetery or Crematory
06/11/2018 Pine View Crematorium
El Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
Z ❑Removal and/or Held
and/or Address
U Hold
O Date Point of
N ❑Transportation Shipment
a by Common Destination
Carrier
El 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 Stpo Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
2 Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/11/2018 Registrar of Vital Statistics 'p6ertA Curtis(ECectronicalrySigned)
(signature)
District Number 5601 Place Glens Falls, New York
l, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W�• Date of Disposition 6113 Ili Place of Disposition f i‘U,., ,.,,fa...,.
LU (address)
CO
(section) hot number) t (grave number)
pName of Sexton or Person in Charg of Premises
W (plea e print)
Signature G%( Title rn�Mt�t �
(over)
DOH-1555 (02/2004)