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O'Donnell, Elsie
__ __. -- „�oryolotsa CARLETON FUNERAL HOME Z 001 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit i ';Name First„�i;�; Middle Last Sex �'ir' Elsie Katherine O'Donnell Female Clil Date of Death Age If Veteran of U.S.Armed Forces, i�! 12/0312017 85 Years War or Dates 1 I Place of Death Hospital, Institution or WCity, Town or Village Glens Falls Street Address Glens Fells Hospital C. Manner of Death©Natural Cause u Accident D Homicide EiSuicide Q Undetermined Q Pending Circumstances Investigation itil Medical Certifier Name Title Jean Vanauken PA W. Address !,f;. 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number 11 i City,Town or Village Glans Falls 5601 621 'l l Date Cemetery or Crematory �i❑BUflal fy1;,i in 12/05/2017 Pine View Crematorium Ilp,LiEntombmentr,iiil!Rol_ Address y!l ®Cremation Queensbury Town, New York . Date Place Removed g❑Removal and/or Held and/or Address Hold li)0 Date Point of 0 TransportationCO Shipment m by Common Destination j,', Carrier i:l l Disinterment Date Cemetery Address u t Date Cemetery Address !;,p,ii Li Reinterment ii(1i j;i1;': Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 ii Address f 66 Main Stpo Box 67,Hudson Fails,New York 12839 , ,,;�W Name of Funeral Firm Making Disposition or to Whom '1 Remains are Shipped, If Other than Above a Address El i. Tt Permission is hereby granted to dispose of the human remains described above as indicated. OI ; Date Issued 12/05/2017 Registrar of Vital Statistics ep6oTA clew w&anmicalrySi med I'P (signature) qpf, 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 I t l t, I n Place of Disposition 6.i%..✓ Af a-- I (address) (section) lot number) C (grave number) p Name of Sexton or Perso In Charge of mises I4? , J su Z (pi se print) 4'i Signature _ rj('f Title j�tcfrAi� — (over) DOH-1555 (02/2004)