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Srait-Neutz, Carol
NEW YORK STATE DEPARTMENT OF HEALTH ' -- ' ' # 1/ti Vital Records Section Burial - Transit Permit Name First Middle Last Sex Carol Sue Srait-Neutz Female Date of Death 1 Age If Veteran of U.S. Armed Forces, 0 3/1 3/2 01 6 7 6 War or Dates Place of Death H a1tal, Institution or Glens Falls Glens Falls Hospital 7 y, Town or Village Street Address Manner of Death®Natural Cause Accident D Homicide 0 Suicide Undetermined Pending t Circumstances Investigation :l Medical Certifier Name Title fl Suzanne M. Rayeski D.O. Address 100 Park St. Glens Falls, NY 12801 Death Certificate Filed District Number ,�- dy Regist��mnber :: Town or Village Glens Falls J OBurial Date Cemetery or matory 03/15/2016 Pine View CreCrematory <: ❑Entombment Address : :©Cremation 21 Park St. Queensbury, NY 12804 . _____T__ Date Place Removed 44❑ Removal and/or Held _ and/or Address W Hold an Date Point of in Li Transportation Shipment a by Common Destination Carrier Date Cemetery Address Q Disinterment • Q Reinterment Date Cemetery Address Permit Issued to MB Kilmer FH Registration Number Name of Funeral Home 01078 Address 136 Main St. South Glens Falls, NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above . 2 Address C W. ` Permission is hereby ranted to dispose of the human remains descebeed ov s i .ted. 3/S20/6 Registrar of Vital Statistics fir/ " . <.:: Date IssuedQ g 1� (signature) District Number f(cC2/ Place C-4,1>• , /, hit I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: tit Date of Disposition 3- 6 -/o Place of Disposition Pi m e 0 4ie./► Ii' 2 (address)I 1i CA IX (section) lo(lott number) (grave number) ci \ Name of Sexton or on in Ch rge of Premises v t i e.-✓� c °'z -4' z (please print) lENi: Signature Title C.-rapl 140o' (over) DOH-1555 (02/2004)