McCarty, Joan NEW YORK STATE DEPARTMENT OF HEALTH i /IL
Vital Records Section Burial - Transit Permit
,.' Name First Middle Last Sex
Joan McCarty Female
--�•. Date of Death Age If Veteran of U.S. Armed Forces,
March 15, 2015 73 War or Dates
FA Place of Death Hospital, Institution or
City, Town or Village Street Address
Manner of Death❑ Natural Cause 0 Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
iii= Circumstances Investigation
at Medical Certifier Name Title
C" David Foote Md,
Address
Rt 4 Hudson Falls, NY 12839
Death Certificate Filed District Number Register Number
:' City, Town or Village 5601 , 1-4 1t
s ❑Burial Date Cemetery or Crematory
March 17, 2015 Pine View Crematorium
nur
❑Entombment
Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
'-zz❑ Removal and/or Held
0 and/or Address
igi Hold
Date Point of
,'u 0 Transportation Shipment
CO' by Common Destination
0 Carrier
❑ Disinterment Date Cemetery Address
mom,
❑ Reinterment
�4 Date Cemetery Address
%
Permit Issued to Registration Number
514 Name of Funeral Home Carleton Funeral Home, Inc. 00281
Aix 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
I Address
a
111
Permission is hereby granted to dispose of the human remains described above as indicated.
Registrar of Vital Statistics 1 -A�
� � Date Issued ���6 l� 9� ����""�
(signature)
District Number 5601 Place 6 S 'FU k 1 S 1 W 7
I certify that the remains of the decedent identified above ere disposed of in accordance with this permit on:
IM Date of Disposition 03/17/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
W
IX (section) _(lot number) (grave number)
g l ` p�— del,,
'. Name of Sexton or Person in Charge of Premises
(please print)
Signatureit: �?-- Title �� "�
(over)
DOH-1555 (02/2004)