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Flint, Nova NEW YORK STATE DEPARTMENT OF HEALTH $ILL Vital Records Section Burial - Transit Permit Name First Middle Last Sex Nova Rae Flint Female Date of Death Age If Veteran of U.S. Armed Forces, November 26, 2017 War or Dates Pi Place of Death Hospital, Institution or ril City, Town or Village Saratoga Springs Street Address Saratoga Hospital ffil Manner of Death El Natural Cause 0 Accident 0 Homicide Suicide El Undetermined 0 Pending Lail iti Circumstances Investigation 63 Medical Certifier Name Title Amos Cutler, M.D Address 211 Church St. Saratoga Springs, NY 12866 Death Certificate Filed District Number Register Number City, Town or Village iS❑Burial Date 7.o Cemetery or Crematory November Ji; 2017 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Address Hold Date Point of Transportation Shipment by Common Destination Carrier _ R, Disinterment Date Cemetery Address Reinterment Date Cemetery Address -, a 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 S Permission is h eby g anted to dispose of the human rem�aifis d cr' ed ab w indicat Date Issued ( C> Registrar of Vital Statistics `� ` �� (signature) District Number 9 3--b' Place Cil ( 5Y0V-)(4,_) I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t f,�,�� Date of Disposition /2017 Place of Disposition Quaker Road Queensbury,NY 12804 ) dleai ,) < +r'"'"7 (address) ori (section) (lot num)er) (grave number) € Name of Sexton o rso 'n Charge of Premises �` l' r" � "� (please print) E a Signature Title G =? 4- (over) DOH-1555 (02/2004)