Davidson, Veronica i
NEW YORK STATE DEPARTMENT OF HEALTH - ''' h' Ill.
Vital Records Section Burial - Transit Permit
Name First Middle
14. Last Sex
Kli Veronica Joy Davidson Female
.--, Date of Death Age If Veteran of U.S. Armed Forces,
02/02/2018 59 Years War or Dates
14 Place of Death Hospital, Institution or
City, Town or Village Glens Faits Street Address Glens Falls Hospital
Manner of Death rigl
ILI Natural Cause El Accident Ei Homicide 0 Suicide n Undetermined ri Pending
1-1Circumstances "'Investigation
Medical Certifier Name Title
David Cunningham MD _ —
'v---4, Address
too Park St,Glens Falls,New York 12801
Death Certificate Filed D. rict Number Register Number
City, Town or Village Glens Falls 1 67
iii OBurial Date . emetery or Crematory
0210612018 Pine View Crematorium
Entombment
•*,-0 Address
-.i IXI Cremation Queensbury Town, New York
Date Place Removed
ri Removal and/or Held
Imt and/or
2.... Address
....; Hold
Date Point of
at' El Transportation Shipment
by Common Destination
7 Carrier
El Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
—
Permit issued to Registration Number
IL 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
X Address
Permission is hereby granted to dispose of the human remains described above as Indicated.
Date Issued 02/0512018 Registrar of Vital Statistics Mat A CiatiS gEaCtrattiarySignea9
(signature)
District Number 5601 Place Glens Falls, New York
-•,, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 71 i lit Place of Disposition IFLI V.N.4 A-410.--1
(address)
Name of Sexton or Person in Charge of Premi s
(section) j(lot numbei)
I 4131(... A'c.01# (grave number)
2,4, (Mese print)
Signature
,4,1L Title litt Pitt P12_
(over)
DOH-1555 (02/2004)
1.