Viele, Betty NEW YORK STATE DEPARTMENT OF HEALTI-f -). 'y
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Betty Jeanne Viele Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 3, 2013 65 War or Dates
M- Place of Death Hospital, Institution or
WCity, Town or Village Hudson Falls Street Address 40 Ferry Street Apt. 2
Cl; Manner of Death X Natural Cause 0 Accident 0 Homicide 0 Suicide Li Undetermined ri Pending
U Circumstances Investigation
Lu I Medical Certifier Name Title
Robert Love, M.D. Dr.
Address
3 Irongate Center Glens Falls, NY 12801
' Death Certificate Filed District Number Registeumber
City, Town or Village 7 of b !
~❑Burial Date Cemetery or Crematory
October 10, 2013 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z Removal and/or Held
and/or Address
p Hold
aCO Date Point of
❑ Transportation Shipment
CO by Common Destination
CI Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. „0Q281
Address
Carleton Funeral Home, Inc. 68 Main St,. Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
2 Address
W'
tZ Permission is hereby granted to dispose of the human remakas,de ribed above as indicated.
'J 61 r1 3 Registrar of Vital Statistics c�.. l�
Date Issued I ki` / :X 9 "
• ` (signature)
--�
District Number J'�:AL Place �-� a���-- � i��►-�� �
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
u Date of Disposition0../.41,4/1-AV� p �()�(��3 Place of Disposition ��//� ���.,/
2 (address)
W
re (section) S" (/�'' tuber) (grave number)
a; Name of Sexton . //�
a P< s•/�" �'arge of Premises �A
W / �� (please print)
Signature �7 11/ Title L .fyrh/ )._ 45)',
(over)
DOH-1555 (02/2004)