Pratt, Ramona NEW YORK STATE DEPARTMENT OF HEALTH{ "
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ramona Jean Pratt Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 21, 2014 85 War or Dates
of Death Hospital, Institution or
UJ Ci own or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death X❑ Natural Cause ❑ Accident El Homicide ❑ Suicide [II Undetermined "—I Pending
CircumstancesInvestigation
W Medical Certifier Name Title
C1' James North, M.D
Address
100 Broad St. Glens Falls, NY 12801
Certificate Filed District Number Register Number
rh
Town or Village Filed,..
le,n s Pal( s 572 0( 3.S2
❑Burial Date Cemetery or Crematory
July 24, 2014 Pine View Crematorium
El Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
co and/or Address
E_ Hold
Date Point of
eL ❑ Transportation Shipment
ll) by Common Destination
3' Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
El 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
re
Wf
G. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12.�,/ r y Registrar of Vital Statistics �c� � ,
7
/ � (signature)
District Number 3 6d rO 1 Place S V,S I I� Y
I certify that the remains�offtthe decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 07/23/2014 Place of Disposition Quaker Road Queensbury,NY 12804
W (address)
Cr)
(section) (lm r), (grave number)
0 hd
a. Name of Sexton or P o in C a of Premises tt''t
Z (please print)
W Signature Title , 1--
(over)
DOH-1555 (02/2004)