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Mulcahy, Darlene c # sq NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Darlene Mary Mulcahy Female Date of Death Age If Veteran of U.S.Armed Forces, 07/31/2017 70 Years War or Dates Place of Death Hospital, Institution or ,`' City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause El Accident El Homicide ID Suicide 0 Undetermined Pending a Circumstances Investigation C: Medical Certifier Name Title Shahid Ahmed MD , Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 415 ❑Burial Date Cemetery or Crematory 08/07/2017 Pine View Crematorium ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed Removal and/or Held -. and/or Address Hold Date Point of Q Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Q 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 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/02/2017 Registrar of Vital Statistics gRg6ertACurtis 'ECectronicafTySigned (signature) District Number 5601 Place Glens Falls, New York certify that the remains of the decedent identified above were disposed of in accordance with this permit on: , ' Date of Disposition gis I n Place of Disposition f4w�,� er itio r..) (address) 74 4 (section) j//// (lot number)(_ (grave number) Name of Sexton or Person in Charge of Premises L�hhs 's -3em4ir (plEase print) Signature '"' Title /k(bF 1 (over) DOH-1555(02/2004)