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Webb, Linda NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permi Name First Middle Last Sex Linda Marie Webb Female Date of Death Age If Veteran of U.S. Armed Forces, February 15, 2011 59 War or Dates Place of Death Hospital, Institution or City, Town or Village Hudson Falls Street Address 101 Boulevard Manner of Death I771 Eki Natural Cause ❑ Accident ❑ Homicide ❑ Suicide 1-7 Undetermined ❑ Pending ;� Circumstances Investigation Medical Certifier Name Title Max Crossman MD, Address North St. Granville, NY 12832 Death Certificate Filed District Number Register Number City, Town or Village S 1 a, k, 0 s To ❑Burial Date Cemetery or Crematory February 21, 2011 Pine View Crematorium t .❑Entombment Address x ,'. ©Cremation Quaker Road Queensbury,NY 12804 P Date Place Removed ❑ Removal and/or Held and/or Address Hold Pine View Crematorium Date Point of ❑Transportation Shipment by Common Destination Carrier , ❑ Disinterment Date Cemetery Address ❑ Reinterment Cemetery Address 10 Permit Issued to Registration Number , Name of Funeral Home Carleton Funeral Home, Inc. 00276 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 '44 Name of Funeral Firm Making Disposition or to Whom , Remains are Shipped, If Other than Above - Address Permission is hereby granted to dispose of the human remains described above as indicated. t. - Date Issued 07- / '-,2 o // Registrar of Vital Statistics,.., C.J . --1, (signature) District Number3 7a 6 Place -" -- 'If --- o� j2(_ y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: gip,, Date of Disposition 02/21/2011 Place of Disposition Quaker Road Queensbury,NY 12804 (address) I F R; y (section) (lot number (grave number) Name of Sexton o Person in Ch rge of Premises � rV V (please print) Signature Title CReM 4T (over) DOH-1555 (02/2004)