Reale, Sandra NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sandra Marie Reale Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 7, 2015 58 War or Dates
t-- Place of Death Hospital, Institution or
w
W- City, Town or Village Queensbury Street Address 40 Meadow Lane
WManner of DeathiLu Natural Cause El Manner ❑Homicide El ❑ Undetermined ❑ Pending
0 Circumstances Investigation
W Medical Certifier Name Title
CI Paul J. Byron MD,
Address
Smith Drive Corinth, NY 12822
Deat --- . ate Filed 9 ` District Number Register tuber
u
Cit , own •"Village e-eA4 _h c i` c,
❑Burial Date \ Cemetery or Crematory
September 10, 2015 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
O and/or Address
Hold
5 Date Point of
a. 0 Transportation Shipment
COby Common Destination
0 Carrier
Date Cemetery Address
El Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
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
• Address
Ce
w
a Permission is hereby granted to dispose of the human rem ns e cribed a a dicate
I Date Issued CA— 10-oCD lc Registrar of Vital Statistics A.,\(
(signature)
District Number cisS`1 Place '40 cam,` J U_e.,e.,,, r1
▪ I certify that the remains of the decedent identified above - : disposed of in accord e with his permit on:
uj• Date of Disposition 09/10/2015 Place of Disposition Q, er Road Queensbury,
W (address)
CO
W (section) (lot numb ) (grave number)
p Name of Sexton or Person incharge of Pr-mises �+t� a4/
Z 'please print)
W Signature ���jjj���--- go
Title t.
(over)
DOH-1555 (02/2004)