Rosati, Josephine 0
NEW PORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
.a.
Name First Middle Last Sex
E...' Josephine Florence Rosati Female
Date of Death Age If Veteran of U.S. Armed Forces,
02/07/2018 89 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death rulLai Natural Cause 1=I Accident 0 Homicide El Suicide ❑Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
0' Wendy Steinhacker '` N PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 70
❑Burial Date Cemetery or Crematory
02/09/2018 Pine View Crematorium
❑Entombment
Address
®Cremation_ Queensbury Town, New York
Date Place Removed
g❑Removal and/or Held
Cand/or Address
Hold
0 Date Point of
',.Q Transportation Shipment
by Common Destination
- Carrier
Di Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
'' Permit Issued to Registration Number
i. 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
f
LU
Permission is hereby granted to dispose of the human remains described above as indicated.
:3 Date Issued 02/08/2018 Registrar of Vital Statistics 4Zo6ertA Curtis(Etectronica ySgned}
(signature)
District Number 5601 Place Glens Falls, New York
- I certify that the remains of the decedent identified above were disposed oofpf in accordance with this permit on:
Date of Disposition 2 i I�il Place of Disposition i .U.,
(address)
R°i
fO
osPM (section) A ;number)number) (grave number)
Name of Sexton or Person in Charge of Premises `L
le Ti
Signature 6ase nt)Title )
� '=I"l4(>ki.
./Z,
(over)
DOH-1555 (02/2004)