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Deso, Rose NEW YORK STATE DEPARTMENT OF HEALTH 0 N.- # /lc Vital Records Section Burial - Transit Permit Name First Middle Last Sex Rose Mary Deso Female iv Date of Death Age If Veteran of U.S. Armed Forces, February 4, 2018 89 War or Dates Place of Death Hospital, Institution or City, Town or Village Street Address 14 Prospect St. Manner of Death 0 Natural Cause D Accident Ej Homicide D Suicide El Undetermined ri Pending 1-1 Circumstances Investigation a „ImlW Medical Certifier Name Title Address Death Certificate Filed District Number Register Number City, Town or Village Burial Date Ce'netery or Crematory February 5, 2018 Pine View Crematorium '11 Entombment Address R'©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or `' Hold Address Pine View Crematorium Date Point of Transportation Shipment by Common Destination aCarrier El Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address , Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address '.;,;, Permission is hereby granted to dispose of the human remain escribed abov as indii ated. Date Issued ,Z— 7—�i rRegistrar of Vital Statistics q i (signature) ®� `� District Number I/$v7'/ Place t/t 1 , B-f cSaiu 7/a42 - ' "� A) 1 kit I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 02/05/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (lotlig number) (grave � (section) /� ft.. number) ZName of Sexton or Person in Charge of Premiss [ i,'-4� i itt F ( ease print) �� Title (PCP Signature M (over) DOH-1555 (02/2004)