Hall, Carolyn .. 7 r • L,
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carolyn M. Hall Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 5,2017 58 War or Dates _
Place of Death Hospital, Institution or
City, Town or Village Granville Street Address Haynes House Of Hope
Manner of Death i x i Natural Cause n Accident Homicide Suicide 1 Undetermined Pending
Circumstances Investigation
us Medical Certifier Name Title
0 Aqeel Gillani MD
Address
. CR Wood Cancer Center, 102 Park St.,Glens Falls,NY 12801
Death ificate Filed District Number Register Number
City, ow or Village GlKc4.Ndll l 57.56 i i
❑Burial Date Cemetery or Crematory
March 10,2017 Pine View Crematory
0 Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
OZ i l Removal and/or Held
and/or Address
▪ Hold
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O Date Point of
351 I Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
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 b 3 I b-110.0 17 Registrar of Vital Statistics a tee
(si nature)
District Number S 7 s(, Place nuAl p F G AN J iu \ N'l
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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1,11 Date of Disposition 3 /a i 7 Place of Disposition ph a,„7 .,,,i G c,„- , ,-
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(section) 1 (Jot number) (grave number)
Q• Name of Sexton or P on i Charge of Premises J /L.,. ,6-,�, C,a,�nc e
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Signature Title G/ ✓lcv j,r—
(over)
DOH-1555 (02/2004)