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Hawkins, Irene NEW YORK STATE DEPARTMENT OF HEALTH sc _I Vital Records Section E Burial - Transit Permit Name First Middle Last Sex Irene Leonora Hawkins Female Date of Death Age If Veteran of U.S. Armed Forces, June 17, 2014 97 War or Dates F— Place of Death Hospital, Institution or W' City, Town or Village Glens Falls Street Address The Pines CI Manner of Death 0 Natural Cause 0 Accident Homicide ❑ Suicide ❑ Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Bernardo R Villajuan MD, Address 161 Carey Road Queensbury, NY 12804 Death Certificate Filed District Number Register�l r ��� City, Town or Village �`�jj p©�� ❑Burial Date Cemetery or Crematory June 18, 2014 Pine View Crematorium Q Entombment Address ®Cremation Date Place Removed z Removal and/or Held O and/or Address E Hold Date Point of a. Transportation Shipment CO by Common Destination CI 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 Permission is hereby granted to dispose of the human remains des ed bo/v�as ' ted. Ar Date Issued ‘ all Registrar of Vital Statistics L'L > C/ / (signature) .5Q'/ District Number Place e/2J //. / /v2Je/ • I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 06/18/2014 Place of Disposition F4tA.J Cr ck-tt-- L (address) W (section) (lot number (grave number) Name of Sexton or Person in harge of Premises —N ( lease print) W Signature --' Title (over) DOH-1555 (02/2004) I