Whitt, Margaret NEW YORK STATE DEPARTMENT OF HEALTH t_ lc (3 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Margaret Florence Whitt Male
Date of Death Age If Veteran of U.S.Armed Forces,
March 3, 2012 82 War or Dates
Place of Death Hospital, Institution or
utY,
City, Town or Village Granville Street Address INDIAN RIVER REHAB & HLTH CARE
sLLl
W= Manner of Death K1 Natural Cause ❑ Accident ❑Homicide El Suicide El Undetermined ❑ Pending
ra Circumstances Investigation
W Medical Certifier Name Title
Address
Death Certificate Filed r District Number Register Number
City, Town or Village c 1. t U&- 57 aii;J S
Burial Date Cemetery or Crematory
March 12, 2012 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
Hold
Vil Date Point of
Transportation Shipment
q) by Common Destination
c3 Carrier
❑ Disinterment Date Cemetery Address
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
2 Address
IX
Ci" Permission is hereb granted to dispose of the human remai aiti: • •�,�l�r �as indicated.
ii
Date Issued �1 J2 Registrar of Vital Statistics e
(signature)
District Numbers- `'7 Place V'RaC.Q o"F- GitLUVItte.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3113112. Place of Disposition .s U & ervr.ef0 Nur,
2 (address)
`ill
M (section) (lot number) (grave number)
Gt Name of Sexton or Pers in Charge of remises c�ii�}'t'(���r ��"�`�
-. 7sji..a.__
t (please print)
L�J` Signature Title C2E ei+Rr6V_
(over)
DOH-1555 (02/2004)