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Eggleston, Eleanor • NEW YORK STATE DEPARTMENT OF Hi*.ALTH 1 2-5 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Eleanor Mary Eggleston Female Date of Death Age If Veteran of U.S. Armed Forces, February 11, 2017 92 War or Dates E Place of Death Hospital, Institution or W City, Town or Village Moreau Street Address 94 Lamplighter Acres Manner of Death FriNatural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title CI Glen Anderson RPA-C, Address Moreau Family Health South Glens Falls, NY 12803 Death Certificate Filed District Nuup b r Registerimber City, Town or Village �I ❑Burial Date Cemetery or Crematory February 14, 2017 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held and/or Address H Hold Pine View Crematorium Date Point of aTransportation Shipment 0) by Common Destination Ll Carrier Date Cemetery Address El Disinterment ❑ 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 I— Remains are Shipped, If Other than Above M Address W a Permission is hereby granted to dispose of the human re • escribe bo e as indicated. Date Issued C9frYbol? Registrar of Vital Stati ics � (sign ture) District Number �9 a Place Ql,� (�1�� Cll/� ldYi , ` M8 ' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 1 W Date of Disposition 02/ 017 Place of Disposition Quaker Road Queensbury,NY 12804 Tih e u i„✓ 2 (address) W 0) Ce (section) (lot number) (grave number) pName of Sexton orrery in Charge of Premises I4 )l c:,vl v�v t.L r, (please print) • 1 W Signature � �` Title C rat 4,1 /zt !'/ (over) DOH-1555 (02/2004)