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Sears, Linda I"I NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Linda Marie Sears Female - Date of Death Age If Veteran of U.S. Armed Forces, January 6, 2016 57 War or Dates Place of Death Hospital, Institution or tU City, Town or Village Saratoga Springs Street Address WESLEY HEALTH CARE CENTER, INC 0 Manner of Death X❑ Natural Cause Accident ❑ Homicide 0 Suicide ❑ Undetermined ri❑ Pending Circumstances Investigation II.UW Medical Certifier Name Title 0 Matthew Pender , M.D. Address 131 Lawrence Street Saratoga Springs, NY 12866 Death Certificate Filed District Number Register Number City, Town or Village y�:>:El Burial Date Cemetery or Crematory January 7, 2016 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed • Removal and/or Held • and/or Address ▪ Hold Pine View Crematorium 63 Date Point of pa„ ❑Transportation Shipment co by Common Destination • Carrier IIIDisinterment Date Cemetery Address IIIReinterment 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 F_- Remains are Shipped, If Other than Above 2 Address W Permission is re y granted to dispose of the human rema de7abop 'ndicate Date Issued ' Registrar of Vital Statistics (signature) District Number L5b Place EEQ ra- V4f \\C\IC3 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /- ,-�� /7ihev, GfQ,r4 .' z W Date of Disposition 01/07/ 016 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) W CO _ W (section) (lot number) (grave number) QName of Sexton or Person in Charge of Premises 1;a N �j�,yl�c,�e Z (please print) IW Signature Title C-t.'-✓✓/moo 7. (over) DOH-1555 (02/2004)