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White, Alice NEW YORK STATE DEPARTMENT OF HEALTH Y t # 1Sy Vital Records Section Burial - Transit Permit Name First Middle Last Sex Alice Ann White Female Date of Death Age If Veteran of U.S. Armed Forces, April 1, 2016 95 _ War or Dates F- Place of Deat• Hospital, Institution or WCity, Town or illag- Hudson Falls Street Address 79 Pearl Street uai- Manner of Dea um Natural Cause ❑ Accident ElHomicide ❑ Suicide ❑ Undetermined ri 1--' Pending CircumstancesInvestigation LU Medical Certifier Nama Title CI _ Michele Harding ANP-C Address 327 Broadway Fort Edward, NY 12828 Deat - ' icate Filed 0 District Nunber Register Number City, Town 'r Village t`N.I ()qJ. b�.1 Li S '7 D /1 ❑Burial Date Cemetery or Crematory April 4, 2016 Pine Vew Crematorium ❑Entombment Address ©Cremation Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held { and/or Address p Hold CD Date Point of Q. ❑Transportation Shipment COby Common Destination a Carrier Date Cemetery Address ❑ Disinterment - Date Cemetery Address ❑ Reinterment 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 M Address CC 0. Permission is hereby granted to dispose of the human remains cribedib above as indicated. Date Issued V-Sf-aG i6 Registrar of Vital Statistics "- (signature) District Number 5-7 a,(0 Place' _ n-s1.0--1›.-_ I certify that the remains of the decedent identified a ve were disposed of in accordance with this permit on: W Date of Disposition 04/04/2016 Place of Disposition Queensbury,NY 12804 M (address) W to re (section) (lot number) .,, (grave number) 0' Name of Sexton or Person in Charge of Premises %to- L i4rv41- z 1 please print) W Signature Title /WARM - (over) DOH-1555 (02/2004)