Greene, Arline If ti010
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section ! --4•. \ Burial - Transit Permit
Name First Middle Last Sex
Arline Geraldine Greene Female
Date of Death Age fir If Veteran of U.S. Armed Forces,
August 12, 2011 72 War or Dates
ZPlace of Death Hospital, Institution or
City, Town or Village Hudson Falls Street Address
W Manner of Death 0 Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
al MedicalMedical Certifier Name Title
0
Anthony Petracca MD,
Address
Three Irongate Center Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village S 7 ,6 l5
0 Burial Date Cemetery or Crematory
August 15, 2011 Pine View Crematorium
0 Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z Removal and/or Held
and/or Address
F. Hold
CO Date Point of
0 Transportation Shipment
CD by Common Destination
Carrier
Disinterment Date I Cemetery Address
Reinterment 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. 0. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
CC
W
d' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued (?-ice` 20 ii Registrar of Vital Statistics ;, W _.
(signature)
District Number S 7 3 6 Place o_ rn.Toi
F I certify that the remains of the decedent identified above wer disposed of in accordance with this permit on:
W Date of Disposition gib-t( Place of Disposition f ,Ugj C ±ft,..
W (address)
re (section) (lot n ber) (grave number)
0 Name of Sexton or Pers in Charge of emises A r• t �•�ir
` (plea`s�Tint)
W Signature Title NTPi .
(over)
DOH-1555 (02/2004)