Loading...
Mears, Carol t 3s1 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Carol Harsha Mears Female ,_ Date of Death Age If Veteran of U.S. Armed Forces, May 8, 2016 90 War or Dates !=- Place of Death Hospital, Institution or WCity, Town or Village Queensbury Street Address The Stanton Nursing & Rehab. Center W' Manner of Death 1 ,irriNatural Cause ❑ Accident 0 Homicide ElSuicide 1-1 Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title In° Suzanne M Blood, MD, Address 14 Manor Dr. Queensbury, NY 12804 Deat , ificate File District Nu er R Aster Number w Ci , Town Village ��� ���� � "'❑Bundl Date Cemetery or Crematory May 10, 2016 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held C�; and/or Address 1=, Hold Union Cemetery CDate Point of L'L ❑Transportation ShJpment CO by Common Destination Carrier r ❑ Disinterment Date Cemery Address Date Cemetery Address ❑ Reinterment 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 Imo' W a" Permission is hereb granted to dispose of the human Peter ains desclibed a as indicated. Date Issueau (�j Registrar of Vital Statistics " (signature) District Number Li, C h Place I O t _( ` - (. .f-,cb I certify that the remains of the decedent identified above were disposed of in accordanc=with t is permit on: W Date of Disposition 05/10/2016 Place of Disposition Quaker Road Queensbury,NY 12804 2, (address) W 0(49 (section) (lot number) (grave number) a Name of Sexton or Person in Charge of emises /Anr� Std"4� 1 (print) 1 Signature Title Cr 14/1131t (over) DOH-1555 (02/2004)