Michaud, Sondra Lee i
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sondra Lee Michaud Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/11/2020 80 Years War or Dates
t. Place of Death Hospital,Institution or
Z City,Town or Village Kingsbury Town Street Address 20 Sue Lane,Kingsbury Town,New York 12839
LIJ
`p Manner of Death XINatural Cause El Accident ElHomicide ❑Suicide �Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Paul Filion MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Kingsbury Town 5762 29
❑Burial Date Cemetery,Crematory or Facility Name
10/13/2020 Pine View Crematorium
ElEntombment Address
]Cremation Queensbury Town,New York
❑Donation
O• ElRemoval Date Place Removed
and/or and/or Held
p.N
Hold Address
0
d Date Point of
Cl) ❑Transportation
by Common Shipment
Carrier Destination
Disinterment
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
1 Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/13/2020 Registrar of Vital Statistics Cynthia Bardin(ECectronica1tySigned)
(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 Pi lights Place of Disposition
g (address)
W
CC (section) /)(tot number) (grave number)
ti-
c Name of Sexton or Person in Charge of P mises °`" ti�
Z (pleisV
W nature Title '"'9VVZ
Signature
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014111
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#