Hall, Carol Hnti
NEW YORK STATE DEPARTMENT OF HEALTN� IIVital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carol A. Hall Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 2,2015 58 War or Dates
t.,. Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
LL1. Manner of Death
IXI Natural Cause I I Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
Q_ Medical Certifier Name Title
Robert W. Sponzo
Address
102 Park St,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
' City, Town or Village Glens Falls 5601 3?ci
❑Burial Date Cemetery or Crematory
Entombment July 6, 2015 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
N I I Transportation j Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped, If Other than Above
M Address
IX
Permission is hereby granted to dispose of the human remains described above as ind'cated.
Date Issued ' / 6 / IS Registrar of Vital Statistics tA.)e,t.A, Q L
(signature)
District Number 5601 Place Glens Falls. N
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z wi Date of Disposition 7/1 p hi'S Place of Disposition i� , errata
2 (address)
COUJ
Z0 (section) (lot numbe (grave number)
Name of Sexton or Person in Charge of Premises I:,}A �
W '(please print)
Signature - Title IItE
(over)
DOH-1555 (02/2004)