Keays, Christine NEW YORK STATE DEPARTMENT OF HEALTH it /
Vital Records Section Burial - Transit Permit
P' Name First Middle Last Sex
kiii Christine Keays Female
0,4 Date of Death Age If Veteran of U.S. Armed Forces,
February 16, 2015 71 War or Dates
,F Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death J Natural Cause 0 Accident, Q Homicide 0 Suicide 0 Undetermined 0 Pending
Circumstances Investigation
L Medical Certifier Name Title
Michael Miles, M.D
Address Is t 4 r
100 Park et Glens Falls, NY 12801
Death Certificate Filed District Number Register Nu ber
City, Town or Village s6a/ 7�
r 0 Burial Date Cemetery or Crematory
February 18, 2015 Pine View Crematorium
0 Entombment Address
'' ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
0 Removal and/or Held
e' and/or Address
Hold
O Date Point of
S:i❑Transportation Shipment
14- by Common Destination
Carrier
F• s Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
• Name of Funeral Home Carleton Funeral Home, Inc. 00281
• Address
4 _ 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
;X Address
L
Lt Permission is hereby granted to dispose of the human remains described above vindicated.
Date Issued 2.) L$/20 Registrar of Vital Statistics IA)
(signature)
• ,A= District Number6-01 Place Weil' � O / ,/2 .ef
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
aDate of Disposition 02/18/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) lot number)(� (grave number)
gName of Sexton or Person in Char a of Premises "PAA
- , (ple se print)
Signature Title t1' "'11 `
(over)
DOH-1555 (02/2004)