Engwer, Jennifer t'
NEW YORK STATE DEPARTME �= TH S fl
.„...
Vital Records Section _ Burial - Transit Permit
Name First Mi dle Last Sex
Jennifer Marie Engwer Female
jiijig Date of Death Age If Veteran of U.S. Armed Forces,
June 23, 2018 52 War or Dates
i' Place of Death • Hospital, Institution or
City, Town or Village Schenectady, NY Street Address El 1 i s Hospi tal
Manner of Death
Q Natural Cause Ei Accident 0 Homicide 0 Suicide El Undetermined �Pending
Circumstances Investigation
to Medical Certifier Name Ti
0. Dr. Nadarajah Balasubramaniam i 140
Addr,e � S tiYL, SL(i
ICY
gig Death Certificate Filed District Number ' Register Number
El City, Town or Village Schenectady 4601
Ili❑Burial Date Cemetery or Crematory 1
June 26, 2018 Pine View Crematorium
>.❑Entombment Address
Cremation Quaker Road, Queensbury, NY
Date Place Removed
rE
Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier •
`??Q Disinterment Date Cemetery Address
>1` Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
>" Name of.Funeral Home Carleton Funeral Home, Inc. 00281
iiiik Address
48 Main Street, PO Box 67, Hudson Falls, NY 12039
Nii Name of Funeral Firm Making Disposition or to Whom
▪ Remains are Shipped, If Other thanAbove '
• Address •
f
Permission is hereby :anted to dispose of the human remains • ,s),j j , •i i,,,,
Mi
' Dgii
ate Issued (ol a 5 � Registrar of Vital Statistics 4
1 signature)
iiiiiiii District Number lk(Q 01 Place__4G�Qncc._\ . ..
1;iiiiiii I certify that the remains of the decedent identified above were di'4.ed of in accordance with this permit on:
li
Date of Disposition 6 /fl(ii Place of Disposition11 (i p
au.,, �°„,G...
(address)
0.
(section) /2 (lot numbr (grave number)
el Name of Sexton or Person in Charge of Premises 1(.. 1 Qe A. t
(lease print)
Signature [�✓� � Title ltfehtiv_
(over)
DOH-1555 (02/2004)