Ryan, Doreen NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Doreen Ann Ryan Female
Date of Death Age If Veteran of U.S. Armed Forces,
09125/2018 58 Years War or Dates
• Place of Death Hospital, Institution or
it City, Town or Village Glens Falls Street Address Glens Falls Hospital
'Q Manner of Death LIE Natural Cause Accident�n Homicide Suicide ❑Undetermined n Pending
Circumstances Investigation
tu Medical Certifier Name Title
ra Mathew Varughese DO
Address
100 Park St,Glens Falls.New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 459
❑Burial Date Cemetery or Crematory
09/2612018 Pine View Crematorium
-z,. ❑Entonmbment Address
�'; ®Cremation Queensbury Town, New York
Date ' Place Removed
❑Removal and/or Held
N and/or Address
Hold
CO
O Date Point of
to Transportation Shipment
3 by Common Destination
t Carrier
Q Disinterment Date Cemetery Address
:: L. 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
• Remains are Shipped, If Other than Above
• Address
i
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/26/2018 Registrar of Vital Statistics p6ert_4 Cultic/EfectrontcaiTySigned)
(signature)
District Number 5601 Place Glens Falls. New York
r
F- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1 lit jig Place of Disposition f akl., Z�j�
2 (address)
2 (section) tnumber) (grave number)
8 Name of Sexton or Person in Charge of Premises 46t�L 3i' tdtd
Z (pleas print)
i Signature �- Title (041142.,
(over)
DOH-1555(02/2004)