Weber, Florence NEW YORK STATE DEPARTMENT OF HEALTH ` 1)--' .t.
Vital Records Section Burial - Transit Permit
' Name First Middle Last Sex
Florence Freda Weber Female
Date of Death Age If Veteran of U.S. Armed Forces,
February 2, 2015 82 War or Dates
Place of Death Hospital, Institution or
iu City, Town or Village Glens Falls Street Address Glens Falls Hospital
9-: Manner of Death X❑ Natural Cause ❑ Accident D Homicide ❑ Suicide ❑ Undetermined ❑ Pending
` Circumstances Investigation
11J; Medical Certifier Name Title
1:1Dr. Sean Bain,
Address
= Death Certificate Filed District Number Register Number
City, Town or Village 5601 b
❑Burial Date Cemetery or Crematory
1,,.wz, February 4, 2015 Pine View Crematorium
• . U Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
. Hold St. Mary's Cemetery
Date Point of
c ❑Transportation Shipment
'0 by Common Destination
0 ' Carrier
ElDi sinterment
Date Cemetery Address
.
. ❑ Reinterment
Date Cemetery Address
.
Permit Issued to Registration Number
` Name of Funeral Home Carleton Funeral Home, Inc. 00281
F
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
Remains are Shipped, If Other than Above
Address
IX
'LU`
1„ Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 2/3 / /5 Registrar of Vital Statistics LA)CA—L,r-y-.32..- LA-L
(signature)
District Number 5601 Place 6 LQI"-5 Fci l 1,S y y
- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
T Date of Disposition 02/04/2015 Place of Disposition Quaker Road Queensbury,NY 12804
-w (address)
Catalfamo
at (section) '�
(lot number) (grave number)
s Name of Sexton or Person in Charge of Premises C4,.Di 'Se►' 61'
( lease print)
LU SignatureZ a' .� Title lroVrll '
(over)
DOH-1555 (02/2004)