Perkins, Linda NEW YORK STATE DEPARTMENT OF HEALTH 4 00
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Linda Anne Perkins Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 24, 2013 65 War or Dates
Place of Death Hospital, Institution or
W City, Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death 0 Natural Cause El Accident 0 Homicide El Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
U Medical Certifier Name Title
Christopher D Hoy, M.D. Dr.
Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District Number ResVIr Number
City, Town or Village 5601
❑Burial Date Cemetery or Crematory
January 28, 2013 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ri I Removal and/or Held
I
O I and/or Address
., Hold
Ua Date Point of
4 ❑ Transportation Shipment
(0 by Common Destination
5 Carrier
❑ 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
[=�. Remains are Shipped, If Other than Above
2 Address
04
LLµ Permission is hereby granted to dispose of the human re sins de ribed ab e as indicted.
Date Issued Registrar of Vital Statistics ‘37 7 A. , C�/`�
1 (ysig�nature)
District Number 5601 Place %� rQ F � ` ,/
l
6
i-
certify that the remains of the decedent identified above were disposed of in accordan a with this permit on:
W Date of Disposition I-30-'3 Place of Disposition ZUa C +tIv_
2 (address)
W
0)
te, (section) of number) (grave number)
0, LLc
8 Name of Sexton or Person in Charge o Premises cry . P % H-
/� (plea e print)
Signature �`° � Title a Old it.
(over)
DOH-1555 (02/2004)