Mallander, Claudia NEW YORK STATE DEPARTMENT OF HEALTH
s I Zgt Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Claudia Villa Mallander Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 11, 2016 89 War or Dates
I— Place of Death Hospital, Institution or
WCity, Town or Village Gansevoort Street Address 326 Duncan Rd.
L"3 Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined 1-1 Pending
W Circumstances Investigation
U'
W Medical Certifier Name Title
CI Robert Beaty MD,
Address
100 Broad St. Glens Falls, NY 12801
Death Certificate Filed Distr4 Number Register umber
City, Town or Village _.--
City, o- Nrcl�1Uitthior(�yj SLo3
❑Burial Date Cemetery or Crematory
April 12, 2016 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
I Hold
CD Date Point of
a. ❑Transportation Shipment
_ by Common Destination
El Carrier
Date Cemetery Address
El Disinterment
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
I— Remains are Shipped, If Other than Above
2 Address
W,'.
CL" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued/31140 Registrar of Vital Statistics I' �'I _
(sig ature)
District Number �fSL03 Place /6LL17i Ut- P/ j1—MjLu ibf/'/(LPd
f- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 04/12/2016 Place of Disposition Quaker Road Queensbury,NY 12804
2; (address)
W (section) (lot number (grave number)
0 Name of Sexton or Person in Charge o remises nr t��
z please print)
Lii Signature Title Wit
(over)
DOH-1555 (02/2004)