Monroe, Aniston NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Aniston Monroe Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 17, 2017 0 War or Dates No
1.i. Place of Death Hospital, Institution or
City, Town or Village City of Albany Street Address Albany Medical Center
0 Manner of Death E Natural Cause E Accident 0 Homicide El Suicide El Undetermined 0 Pending
0.Lei Fetal Death Circumstances Investigation
til Medical Certifier Name Title
l3 Scott Dexter, MD
Address
43 New Scotland AVenue Albany, NY 12208
Death Certificate Filed District Number Register Number
City, Town or Village City of Albany 101
Nil['Burial Date Cemetery or Crematory
07/25/2017 Pine View Crematorium
❑Entombment Address
;'• EICremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
I:: Hold
CO
0 Date Point of
to Li Transportation Shipment
a by Common Destination
Carrier
El Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
•
Permit Issued to Registration Number
Name of Funeral Home . Carleton Funeral Home, Inc. 00281
Address
68 Main Street, PO Box 67, Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
04 Remains are Shipped, If Other than Above
Address
Ia
f' Permission is hereby granted to dispose of the human rem•'ns • - • - ; ab• - a ' dic• ed.
la Date Issued O7^23-gyp/"7 Registrar of Vital Statistics
/ signature)
District Number 101 Place Albany Police Dept.
I certify that the remains of the decedent identified above were disposed of in : cordance with this permit on:
lit Date of Disposition 7`7.o//7 Place of Disposition ?Me- 1J iek) efeyn4...4/+,
a ( (address)
Cl) «<
CC (section) \ (lot tuber) (grave number)
Name of Sexton o C rge of Premises J IA-/t N bamcl-dt
Z. (please print)
Signature Title 1 e me o/
(over)
DOH-1555 (02/2004)