Mager, Eleanor NEW YORK STATE DEPARTMENT OF HEALTH r . 1 T/ g,g
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Eleanor Lynne Mager Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 18, 2017 73 War or Dates —
i=
Place of Death Hospital, Institution or
W City, Town or Village Street Address 26 Schuyler Way North
Manner of Death rnEl Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined 1-1❑ Pending
Circumstances Investigation
LU Medical Certifier Name Title
t:]: Darci Gaiotti-Grubbs, Dr.
Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Numb Register umber
City, Town or Village `4;\aY�-\(- v mb2Y\d�lr LA to I ,
t=Iv ❑Burial Date Cemetery or Crematory
` November 20, 2017 Pine View Crematorium
❑Entombment Address
z „®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑
Removal and/or Held
and/or
Hold Address
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
❑ Reinterment
Date Cemetery Address
' = 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
Remains are Shipped, If Other than Above
Address
W
, Permission is hereby granted to dispose of the human remains described above as indicated.
mot Date Issued t\ K7 I ('7Statistics ��Registrar of Vital � Q , L
I - (signs re)
District Number `--��� Place L'7c_Y t,,1�
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 11/20/2017 Place of Disposition Quaker Road Queensbury,NY 12804
g.
(address)
;ILIA
(section) (lot number) (grave number)
01
a Name of Sexton or Person in Charge of Premise I i S6h0d
(phase print)
Signature k— Title (PCi)14 TIlL.
(over)
DOH-1555 (02/2004)