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Varden, Eleanor NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit a4 Name First Middle Last Sex Eleanor Julia Varden Female Date of Death Age If Veteran of U.S.Armed Forces, 09/05/2017 102 Years War or Dates I- Place of Death Hospital, Institution or lit City, Town or Village Granville Village Street Address Indian River Rehabilitation And Nursing Center a Manner of Death©Natural Cause El ID ❑Suicide El❑Undetermined ❑Pending its' Circumstances Investigation tu Medical Certifier Name Title Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Granville Village 5725 24 ';❑Burial Date Cemetery or Crematory 09/08/2017 Pine View Crematorium El Entombment Address ®Cremation Queensbury Town, New York Date Place Removed 0❑Removal and/or Held -. and/or Address Hold rn Q Date Point of y❑Transportation _ Shipment by Common Destination 1 Carrier Tit 1-1`'❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number _. Name of Funeral Home Carleton Funeral Home Inc 00281 .: Address 68 Main Stpo Box 67,Hudson Falls,New York 12839 IF Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address CZ W 12. Permission is hereby granted to dispose of the human remains described above as indicated. w. Date Issued 09/08/2017 Registrar of Vital Statistics Richard ,&erts 5 ctronicallySigned (signature) ` District Number Place -, 5725 Granville Village, New York 1-' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: p a(I;i In Disposition1 twtt.) G�"'w W Date of Disposition Place of -� W (address) ta (section) 91 t number) c (grave number) Name of Sexton or Person in Charge of Premises ('^re Zr (ples e print) W', Signature0 Title i �=4 4. 4._ (over) DOH-1555 (02/2004)