Stimpson, Luneda NEW YORK STATE DEPARTMENT OF HE/&TJ-i, 5
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Luneda Joy Stimpson Female
,gi Date of Death Age If Veteran of U.S. Armed Forces,
a. 12/8/2016 91 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Milton• •i Street Address 885 Middle Line Road Lot 109
Manner of Death ®Natural Cause Accident Homicide SuicideriUndetermined ri Pending
1-4 Circumstances Investigation
119 Medical Certifier Name Title
a Nicoleta Daraban, MD
Address
254 Church St Saratoga Springs, NY 12866
<' Death Certificate Filed District Number Register Number
City, Town or.Village Milton 4�(Q \ J O
Date Cemetery or Crematory
❑Burial 12/12/2016 Pine View Crematorium
Address
2 Cremation Queensbury, NY
Date Place Removed
0 ❑Removal and/or Held
and/or Address
Hold
0 Date Point of
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
•
Reinterment Date Cemetery Address
>< Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc 00281
•`i> Address
68 Main St PO Box 109 Hudson Falls NY 12839
, Name of Funeral Firm Making Disposition or to Whom
,,,,�
Remains are Shipped, If Other than Above
IfAddress
iM Permission is hereby granted to dispose of the human re ins describe ore asandicated.
Date Issued la--\to 1 lip Registrar of Vital Statisti. N' ' ' q
(signature)
14 District Number�'5 0\ Place C- (: W
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
t~-
a Date of Disposition /7/15/I t Place of Disposition R,t e L1 r e W Cleyyi�;jp/'�J
(address) /
iu
t (section) (lot�rumber} (grave number)
D Name of Sexton r erson in Charge of Premises —)to 11 " (>,:.' ,lit 4-al
2
(please print)
Signature Title G le/YI ie), -
(over)
DOH-1555 (9/98)