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Curren, Charlotte , .' s 3 0 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Charlotte L. Curren Female Date of Death Age If Veteran of U.S. Armed Forces, April 18,2015 82 War or Dates Place of Death Hospital, Institutior ie Stanton Nursing & Rehabilitation City, Town or Village Queensbury Street Address Centre Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation tu Medical Certifier Name Title G Suzanne M.Blood Address 14 Manor Drive,Queensbury,NY 12804 Death Certificate Filed District Number toter Number City, Town or Village Queensbury 5657 ❑Burial Date Cemetery or Crematory April 27,2015 Pine View Crematory Entombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held 2 and/or Address H Hold CO O Date Point of N Transportation 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 Remains are Shipped, If Other than Above • Address Et El utl Permission is hereby granted to dispose of the human re ains described ab etas indicated. Date Issued t l a'c40l Registrar of Vital Statistics (signature) District Number 5657 Place Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ui Date of Disposition cJ/1St is Place of Disposition W (ad ress) N (section) 1 (lot nutpber) (grave number)Name of Sexton or Person in C arge of Premises 1. ' (please print) Signature +,-- Title ((P-slaaL., (over) DOH-1555 (02/2004)