Loading...
Cartier, Denise r _" NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Denise Cartier F ` ' Date of Death 1 1 /1 $/2 01 6 Age 7 2 If Veteran of U.S. Armed Forces, War or Dates 14 Place of Death Hospital, Institution or Washington Center City, Town or Village Argyle Street Address Manner of Death D Natural Cause E Accident C Homicide []Suicide � Undetermined C Pending Circumstances Investigation at Medical Certifier Name Title 0 Jennifer Hayes MD Address 4573 State Route 40, Argyle,NY 12809 Death Certificate Filed Argyle Dist ct Numb© Regist N mber Cityfi ov or Village Ar le "� >>El Burial Date 1 1 /21 /201 6 Cemetery or Crematory Pine VIew Crematory ❑Entombment Address ®Cremation 21 Quaker Rd, Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Address "` Hold 1n . 0 Date Point of &C Transportation Shipment is by Common Destination Carrier `'El Disinterment Date Cemetery Address 0 iii Reinterment Date Cemetery Address <« Permit Issued to Registration Number >' Name of Funeral Home MB Khmer Funeral Home 01 079 Address 82 Broadway, Fort Edward,NY 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address • CC rt Permission is hereby granted to dispose of the human remains described above as indicated. ''`: Date Issued //`////6, Registrar of Vital Statistics a rn cl(.e,n�-, (signature) District Number 57,, , Place ...-7--;fr i. 6,1 t «<.. I certify that the remains of the decedent identified above were isposed of in accordance with this permit on: 141 Date of Disposition /Hutt, Place of Disposition fut.L. Cr cfori.-4 (address) w tatit (section) /9 (lot number) (grave number) ti Name of Sexton or Person in Charge of Premises 6 '1 rif t'number) t - 2 lease print) tit Signature �� Title CTU_�Mt (over) DOH-1555 (02/2004) '