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Deangelus, Paula NEW YORK STATE DEPARTMENT OF HEALTH ( N., ,q (1y0 Vital Records Section Burial - Transit Permit '-' Name First Middle Last Sex Paula Deangelus Female Date of Death Age If Veteran of U.S. Armed Forces, May 31, 2018 71 War or Dates Place of Death Hospital, Institution or I ]' City, Town or Village Queensbury Street Address 32 Pinecomb Drive IV Manner of Death Iv,Natural Cause 0 Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title Charles Yun, MD Address Glens Falls, NY 12801 , Death rtificate File District Number Register Number 0 City, own-bcVillage� 0 ,-grael Coc 4,❑Burial —' Date ( Cemetery or Crematory June 4, 2018 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold 63 Date Point of 0 Transportation Shipment ,t, by Common Destination C Carrier ❑ Disinterment Date Cemetery Address ❑ Reinterment Date Cemetery Address A 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 tic Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address IX W. Permission is hereby granted to dispose of the human re ins describedI r (signature) District Numbe ggl Place 1 c u—vm 0( a i.. ..y,5 I certify that the remains of the decedent identified above were disposed of in acco •ance wit, this permit on: W..... Date of Disposition 06/04/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) iLt =0:, Le; (section) // (lot number) (grave number) :b„; Name of Sexton or Person in Charge of Pr mises ' i Sd.,%4 lit ( lease pent) Signature C Title ' init `!L (over) DOH-1555 (02/2004)