Boettcher, Emmy 4 111
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
N : Name First Middle Last Sex
Emmy Boettcher Female
. r Date of Death Age If Veteran of U.S. Armed Forces,
April 23, 2012 90 War or Dates
i
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address St. Peter's Hospital
.g Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
.0 Medical Certifier Name Title
Edwin R.Windle,MD
Address
w'315 S.Manning Blvd.,Albany,NY 12208
Death Certificate Filed District Number101 Register Number
, City, Town or Village Albany,NY gas
❑Burial Date Cemetery or Crematory
April 25,2012 Pine View Crematory
0 Entombment Address
O Cremation Queensbury, NY
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
CO
0 Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
e Permit Issued to Registration Number
: Name of Funeral Home Carleton Funeral Home 00281
-
:- Address
,- 68 Main Street,Hudson Falls, NY 12839
°°; Name of Funeral Firm Making Disposition or to Whom
b ; Remains are Shipped, If Other than Above
5 Address
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 4/24/2012 Registrar of Vital Statistics Li/2.4),v_ 0. /0_,au
e
Sl J (signatur
, District Number 101 Place Albany,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Date of Disposition 5Il1III- Place of Disposition fcp w t i.s Qr i,L..
2 (address)
CO
Q0 (section) (lot number)_. (grave number)
Name of Sexton or Pers n in Charge of Premises ( r} Se...1i-
W D (please print)
Signature /�v Title CR6,1M yFTpUL,
(over)
DOH-1555 (02/2004)