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Murray, Margaret Rose IT 1 , NEWYORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margaret Rose Murray Female Date of Death Age If Veteran of U.S.Armed Forces, 10/12/2020 84 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Kingsbury Town Street Address 23 Hickory Lane,Kingsbury Town,New York 12839 Manner of Death ©Natural Cause Accident 1=1 Homicide I=1 Suicide El Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title CI Jean Hanson PA Address 325 Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Kingsbury Town 5762 30 ElBurial Date Cemetery,Crematory or Facility Name 10/14/2020 Pine View Crematorium ElEntombment Address 0 Cremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held - Hold Address 0 O. Date Point of U/) u Transportation p by Common Shipment Carrier Destination EiDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom ▪ Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/14/2020 Registrar of Vital Statistics Cynthia Bard n(E(ectronicalTySigned) (signature) District Number 5762 Place Kingsbury Town, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition Nits no Place of Disposition 2 (address W CC (section) otnumber) (grave number) 8 Name of Sexton or Person in Charge of P miles n c5.u!T Z (plea print) W Signature l�l Title PItt- DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) _'` 014110 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit I Official Funeral Directors Reg.or License#