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Purdy, Gertrude NEW YORK STATE DEPARTMENT OF HEALTH " " i 717 y Vital Records Section Burial - Transit Permit Name First Middle Last Sex Gertrude Isabel Purdy Female Date of Death Age If Veteran of U.S. Armed Forces, April 11, 2016 96 War or Dates 4W Place of Death Hospital, Institution or City, Town or Village Queensbury Street Address The Stanton Nursing & Rehab. Center WManner of Death X❑Natural Cause 0 Accident 0 Homicide ❑ Suicide ❑ Undetermined ❑ Pending Ili Circumstances Investigation W Medical Certifier Name Title 0 Suzanne Blood, M.D. Dr. Address 14 Manor Drive Queensbury, NY 12804 Death ' icate Filed � - _�� District Number R t,�r Number City, own o Village - 1,t 5657 0 Burial Date Cemetery or Crematory April 13, 2016 Pine View Cemetery ❑Entombment Address ©Cremation Quaker Rd. Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held • and/or Address H Hold U'. Date Point of a„ ❑Transportation Shipment 0) by Common Destination in Carrier Date Cemetery Address ❑ Disinterment • ElReinterment 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 -. Remains are Shipped, If Other than Above • Address I' 1.1.1 Permission is hereby granted to dispose of the human rgmains descriy�d ab veAs indicated. 1 Date Issued L"l L I registrar of Vital Statistics `"l}- >G�__ (—� 'S J1..-t-.),,—. -- (signature) District Number 5657 Place 1 U ls-_rV 0 -- c L-A Q • I certify that the remains of the decedent identified above were disposed of in accor nce wit this permit on: li E Date of Disposition 04/13/2016 Place of Disposition Quaker Rd. Queensbury,NY 12804 (address) i i'; C; (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises art 5- IP Z F(q ease print) Signature � f .,1 Title (PAPIIR (over) DOH-1555 (02/2004)