Lanfear, Catherine NEW YORK STATE DEPARTMENT OF HEALTH , r # 4 s 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Catherine Marie Lanfear Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 14, 2016 53 War or Dates
ZPlace of Death Hospital, Institution or
W City, Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death Natural Cause ❑ Accident El Homicide Homicide Suicide ❑ Undetermined ❑ Pending
W; Circumstances Investigation
W Medical Certifier Name Title
C Gamal Khalifa, M.D. Dr.
Address
100 Park Street Glens Falls, NY 12801
Death Certificate Filed District Nu Register tuber
mber
City, Town or Village ✓✓ / ,
❑Burial Date Cemetery or Crematory
June 20, 2016 Pine View Crematorium
❑Entombment Address
X❑Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
j and/or Address
�' Hold
CO Date Point of
• ❑Transportation Shipment
`co by Common Destination
Sri Carrier
Date Cemetery Address
El Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. I 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
j Remains are Shipped, If Other than Above
' Address
ck:
W
Ci" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued , /J4, //6 Registrar of Vital Statistics (}0 CA J. r ' t igA'�� '
((�� 1 (signature)
District Number 560 , Place 6 (.(2/V/LS FcA ( t s 0 O
/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W'' Date of Disposition 06/20/2016 Place of Disposition Quaker Road Queensbury,NY 12804
2' (address)
W
IX (section) e(lot number)�' (grave number)
a Name of Sexton or Person in Charge of Premises !N,r kr- 5ii�.ka`
z
/ease print)
W Signature 1'L. 4..____,.. Title EMI T7
it
(over)
DOH-1555 (02/2004)