Hobbs, Rebecca NEW YORK STATE DEPARTMENT OF HEALTH ' it bi C
Vital Records Section r I Burial - Transit Permit
T Name First Middle Last Sex
Rebecca Hobbs Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 27, 2014 48 War or Dates
I-= Place of Death Hospital, Institution or
wCity, Town or Village Glens Falls Street Address Glens Falls Hospital
W' Manner of Death El Natural Cause Accident E Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0; Daniel Way, M.D Dr.
Address
North Creek Health Ctr Warrensburg, NY
Death Certificate Filed District Numb Re�I' r umber
City, Town or Village eG` 1 L t
❑Burial Date Cemetery or Crematory
September 29, 2014 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
I' Hold
07 Date Point of
e. ❑Transportation Shipment
N by Common Destination
0 Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
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
W'
IL Permission is hereby granted to dispose of the human remains described above as in icated.
Date Issued C f 2.9 I i 9 Registrar of Vital Statistics k,,k)C,k v-Q. \.1 -)
1 (signature
District Number 5 60 I Place 6 Lcziv,s \\S ,, N y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I-i
W', Date of Disposition 09/29/2014 Place of Disposition Quaker Road Queensbury,NY 12804
M (address)
W
GO
(section) (lot number)eC (grave number)
pName of Sexton or Person in Charge of Premises ��r,sltpkr �kh. t
Z (please print)
Wt Signature Ctp Title Caen,Nicii
(over)
DOH-1555 (02/2004)