Carpenter, Shari-Ann NEW YORK STATE DEPARTMENT OF HEALTH I f II 4 S g
Vital Records Section Burial - Transit Permit
gi Name First Middle Last Sex
ni Shari-Ann Carpenter Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/08/2016 48 War or Dates No
} Place of Death Hospital, Institution or
City, Town or Village City of Albany Street Address Albany Medical Center
144
a Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined 0 Pending
tit Circumstances Investigation
Ca
in Medical Certifier Nam A ' Title
ig 1.(..xie.R.:1- Pilthifik i
Address
AMCH 43 New Scotland Avenue Albany, NY 12208
Death Certificate Filed District Number Register Number
ia City, Town or Village City of Albany 101 -2- 7 9
lii!iliElBurial Date Cemetery or Crematory
12/12/2016 Pine View Crematorium
❑Entombment Address
_ ill®Cremation Queensbury, I •
Date Place Removed
Removal • and/or Held
1-1 and/or
Address
CA
Hold
O Date Point of
la 0 Transportation Shipment
is • by Common Destination
Carrier •
Disinterment Date Cemetery Address
iiiN El •
Reinterment Date Cemetery Address
Mili Permit Issued to Registration Number
ini Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
68 Main Street, PO Box 67, Hudson Falls, NY 12839
111 Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than'Above
2 Address
at .
IIU
` Permission is hereby granted to dispose of the huma ains described a ove as indicated.
liii Date Issued )2.) i Z/ /b Registrar of Vital Statistic 2— L,\(\_,
ignature)
Ei District Number 'b, Place ,i-11--- o ki , ,
,...,,,,,,,,,,,, I certify that the remains of the decedent identified 4bLe were disposed of in accor a ce with this permit on:
iii• Date of Disposition Iz i ll i tt Place of Disposition ,neU ov (', . ;—
(address)
U
>I
C (section) (lot number) (grave number)
0• Name of Sexton or Person in Charge of Premises ` t4 ' -)`°`"14--
lease print)
Ul piii Signature ( / ;? Title i fM+iPC.
(over)
DOH-1555 (02/2004)