Caprood, Helen NEW YORK STATE DEPARTMENT OF HEALTH /`
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
,, Helen C.Caprood Female
Date of Death Age If Veteran of U.S. Armed Forces,
a , 02/14/2018 98 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens FallsLU Street Address Glens Falls Hospital
W0 Manner of Death® Natural Cause ❑Accident ❑Homicide Suicide Undetermined Pending
Circumstances Investigation
tit Medical Certifier Name Title
0 Jean Vanauken PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 85
El❑Burial Date Cemetery or Crematory
Rim
02/15/2018 Pine View Crematorium
Entombment Address
cam:
®Cremation Queensbury Town, New York
Date Place Removed
XEl Removal and/or Held
and/or Hold Address
0 Date Point of
tiEl Transportation Shipment
9 by Common Destination
Carrier
Disinterment
Date Cemetery Address
R' Date Cemetery Address
Reinterment
Permit Issued to Registration Number
°,« Name of Funeral Home Carleton Funeral Home Inc 00281
Address
t 68 Main Stpo Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above —
Address
U
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/15/2018 Registrar of Vital Statistics Robert A Curtis teEfr.ctronicalfy Signed)
(signature)
4
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 2170 II$ Place of Disposition Fn0—• c
W (address)
L7 (section) d(lot numb r (grave number)
8 Name of Sexton or Person in Charge of remises
b !
[.� ( ease nt)
Signature Title 1iErbtViti
AP-
(over)
DOH-1555 (02/2004)