Kuster, Lillianne NEW YORK STATE DEPARTMENT OF HEALTH
Z7S
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lillianne Marguerite Kuster Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 1, 2017 83 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Kingsbury Street Address 311 Kingsbury Road
1 Manner of Death nj Natural Cause ❑ Accident 0 Homicide E Suicide ❑ Undetermined ❑ Pending
tY Circumstances Investigation
kik Medical Certifier Name Title
Address
y Death Certificate Filed District Number Register Number
City, Town or Village 57((, 'a 0 9
_❑Burial Date Cemetery or Crematory. April 4, 2017 Pine View Crematorium
07
❑Entombment Address
}_ ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
. : by Common Destination
Carrier
s ❑ Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
a„3,
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
lac
1,47
g Permission is hereby granted to dispose of the human remains described above as indicated.
• Date Issued q--LE-aC I 7Registrar of Vital Statistics j2; i --
(signature)
s District Number 5 Place ��' c, `-
I certify that the remains of the decedent identified abbive were disposed of in accordance with this permit on:
Date of Disposition 04/04/2017 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) /4, (lot number) (grave number)
0' Name of Sexton or Person in Charge of Pre ises / c \,sr- S(M1t,ft-
(p ase print)
Signature Title MliPiL
(over)
DOH-1555 (02/2004)