French, Edith NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edith Florence French Female
Date of Death Age If Veteran of U.S.Armed Forces,
June 11, 2015 89 War or Dates
Place of Death Hospital, Institution or
W City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Eu Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
WCircumstances Investigation
W Medical Certifier Name Title
O Noelle Stevens, M.D. Dr.
Address
100 Broad St. Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village 5601 '3 0 2
❑Burial Date Cemetery or Crematory
June 15, 2015 Pine View Crematorium
;,,❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z. ❑ Removal and/or Held
and/or Address
E Hold
CO Date Point of
p ❑Transportation Shipment
CD by Common Destination
Q Carrier
` ❑ Disinterment Date Cemetery Address
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
�'3 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
w
LL' Permission is hereby granted to dispose of the human remains described above as indicated.
Registrar of Vital Statistics v ,� M.�
Date Issued �j`t 5�� g � ignature)
District Number 5601 Place 6(0„..5 F Is
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— ` 'ne th t ) c4"tw►4%wr,u..•N
W Date of Disposition 06/15/2015 Place of Disposition Quaker Road Queensbury,NY 12804
. (address)
LIJ
Ca)
Ce (section) (lot number) (grave number)
p; Name of Sexton or Person in Charge of Premises t o`-ky S.),-..e/k
Z 1�, (please print)
LU Signature -� Title Crtr•,4��ry +t sl-‘
(over)
DOH-1555 (02/2004)