Wade, Isabelle 0 7' 25J
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
u:' Name First Middle Last Sex
Isabelle Eunice Wade Female
. Date of Death Age If Veteran of U.S. Armed Forces,
` March 18, 2017 86 War or Dates
• Place of Death Hospital, Institution or
• City, Town or Village Argyle Street Address 2119 Lick Springs Road
Manner of Death m Natural Cause El Accident El Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
W Medical Certifier Name Title
Ck
Address
Death Certificate Filed District Number Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
March 21, 2017 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
QEl Removal and/or Held
and/or
Hold Address
E Pine View Crematorium
CO Date Point of
❑Transportation Shipment
by Common Destination
• Carrier
.............
❑ Disinterment Date Cemetery Address
Date Cemetery Address
❑ Reinterment
• 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
I— Remains are Shipped, If Other than Above
-2 Address
u
fit" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3) i 11 n Registrar of Vital Statistics Sect `4._ .(z„,
(signature)
• District Number S-1 5o Place Avg. 1t t ki y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2 Z.
Date of Disposition 03/V/2017 Place of Disposition Quaker Road Queensbury,NY 12804 bli e-t
,r (address)
U
Ce (section) k 9.10t number) (grave number)
• Name of Sexton or so in Charge of Premises 1A-1 i Gy-IA C ac.X.
z (please OM)
Signature Title e � d�
(over)
DOH-1555 (02/2004)