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Granger, Paulette I. NEW YORK STATE DEPARTMENT OF HEALTH ! d Vital Records Section Burial - Transit ermit Name First Middle Last Sex Paulette A. Granger Female Date of Death Age If Veteran of U.S. Armed Forces, 09/27/2016 73 years War or Dates . Place of Death Hospital, Institution or III City, Ta6illIXXr Xlq ( Glens Falls Street Address Glens Falls Hospital a Manner of Death D Natural Cause D Accident ❑Homicide ❑Suicide 0 Undetermined 0 Pending W Circumstances Investigation j Medical Certifier Name Title a William Cleaver Attending Physician Address 100 Park St Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, TXr MflrC Glens Falls 5601 503 El Burial Date Cemetery or Crematory 09/28/2016 Pine View Cemetery ['Entombment Address ©Cremation Queensbury, NY 12804 Date Place Removed Z❑Removal and/or Held F- and/or Address — Hold O Date Point of N ❑Transportation Shipment 0 by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address P O Box 277 Fort Ann, N Y 12827 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above 2 Address cc a' Permission is hereby granted to dispose of the human mains described above as in,,icate . Date Issued 09/28/2016 Re istrar of Vital Statistics , g OT�Py� .lg si nature District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance this permit on: UlDate of Disposition 9(t fit Place of Disposition frt.1,0,..., 6 nc ;_i(address) W N 0 (section) // (lot number) (grave number) ta Name of Sexton or Person in Charge of remises 1 t g.f ..5e^''� 41 z �/ (plbase print) W Signature Lit Title �p �""1`�r. (over) DOH-1555 (02/2004)