Paradis, Carol NEW YORK STATE DEPARTMENT OF HEALTH /663
Vital Records Section
Burial - Transit Permit
Name First Middle Last Sex
Carol L Paradis Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 7, 2014 70 War or Dates
11— Place of Death Hospital, Institution or
W City, Town or Village Glens Falls Street Address Glens Falls Hospital
W▪ Manner of Death I Natural Cause El Accident 0 Homicide 0 Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
W Medical Certifier Name Title
W
Gregory A Kelly, M.D.,
Address
747 Upper Glen Street Queensbury, NY 12804
Certificate Filed District Number Register Number
Cit own or Village «l , s Fa r s 5601 tin
0 Burial Date Cemetery or Crematory
June 9, 2014 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
O and/or Address
E' Hold Union Cemetery
0' Date Point of
eL ❑Transportation Shipment
(1) by Common Destination
a Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ 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
1_--' Remains are Shipped, If Other than Above
Address
IX
W'
Permission is hereby granted to dispose of the human remains d �d a ve icated.
Date Issued 04/,, 0!" Registrar of Vital Statistics
(signature
District Number 5601 Place C4-6..0 '�9// /fhvs, ) 0
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 06/09/2014 Place of Disposition Quaker Road Queensbury,NY 12804
2 (address)
W'
CO
c (section) A (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises ar,,,tefitr Se tit*
(please print)
W Signature dpl.� / -- Title CliCw1
(over)
DOH-1555 (02/2004)