Murray, Emma NEW YORK STATE DEPARTMENT OF HEALTH` ' • A 3Z(
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Emma Louise Murray Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 16, 2014 95 War or Dates
Place of Death Hospital, Institution or
W City, Town or Village, Saratoga Springs Street Address Saratoga Hospital
C Manner of Death J Natural Cause ❑ Accident El Homicide ❑ Suicide n Undetermined ri❑ Pending
Circumstances Investigation
UWI Medical Certifier Name Title
Mikhail Mavashev, M.D
Address
Saratoga Hospital Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City, Town or Village 2 �J
❑Burial Date Cemetery or Crematory
May 19, 2014 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
• ❑ Removal and/or Held
and/or Address
E,' Hold
0 Date Point of
d'❑ Transportation Shipment
CO by Common Destination
CI; Carrier
Li Disinterment Date Cemetery Address
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
I- Remains are Shipped, If Other than Above
Address
w
a. Permission is he by ranted to dispose of the human remai�de ri abottp 'ndicate
Date Issued Registrar of Vital Statistics
,-,, .; ` (signature)
District Number �,dsb I Place SARATOGA SPRINGS
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
th Date of Disposition 05/19/2014 Place of Disposition Quaker Road Queensbury,NY 12804
g' (address)
W
(section) ii(lot number) r. (grave number)
€• Name of Sexton or Person ' Charge of Premises �"/f1; '-':iWit
z' (please print)
W' SignatureL Title "'mom`
(over)
DOH-1555 (02/2004)