Strever, Muriel II-
NEW YORK STATE DEPARTMENT OF HEALTH 1 rz._
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Muriel Elaine Strever Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 15, 2015 94 War or Dates
Place of Death Hospital, Institution or
uj City, Town or Village Glens Falls Street Address The Pines
W! Manner of Death 0 Natural Cause El Accident El Homicide ❑ Suicide ❑ Undetermined El❑ Pending
Circumstances Investigation
LU Medical Certifier Name Title
CI Kenneth France,
Address
170 Warren Street Glens Falls, NY 12801
Death Certificate Filed District Number 560) Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
June 17, 2015 Pine Vew Crematorium
❑Entombment Address
®Cremation Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
Hold
a Date Point of
CL ❑Transportation Shipment
CO by Common Destination
CI Carrier
Date Cemetery Address
El Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
r Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
CZ
a Permission is//hereby granted to dispose of the human remains described above as indicate .
b Date Issued ( -7 ( (, Registrar of Vital Statistics WCA.A.4-v—Z. l/\.)
(signature)
District Number 5 bQ, ) Place 6\Q2.,,S cN 1, c, 11J 7
161. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w; Date of Disposition 06/17/2015 Place of Disposition Queensbury,NY 12804
(address)
W
CO
Cd (section) (lot number) (grave number)
a' Name of Sexton or Pers Al,n C arge of Premises L ^� j �
z lease print)
W Signature '" Title aZ4 .
(over)
DOH-1555 (02/2004)