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Ostranter, Marie NEW YORK STATE DEPARTMENT OF HEALTH I(J C Vital Records Section Burial - Transit Permit Name First Middle Last Sex Marie Elizabeth Ostrander Female Date of Death Age If Veteran of U.S. Armed Forces, November 16, 2013 82 War or Dates Place of Death Hospital, Institution or illCity, Town or Village Johnsburg Street Address Adirondack Tri County HCF WManner of Death j Natural Cause El Accident 0 Homicide Suicide 0 Undetermined El Pending U Circumstances Investigation W. Medical Certifier Name / �� Title �a v„u1 (-�,c\ J i a Address 1©tkti) )j-, -, ✓11 Death Certificate Filed j District Number Register Number City, Town or Village (f p 0 Burial Date Cemetery or Crematory November 22, 2013 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed zn Removal and/or Held 0 and/or Address F Hold a Date Point of 0 Transportation Shipment Q. by Common Destination Carrier EilDisinterment 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 LU "'- Permission is hereby granted to dispose of the human ins descri ed ab ve as indicated. Date Issued - t - Registrar of Vital Statisticsc ,, Q.x&, (signature) District Number 562 c 5 Place v c 1 <j F- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: a Date of Disposition If Disposition p 1S-t3 Place of Dis osition Zil4o ��Klof,- W (address) CO C (section) (lot n mber) (grave number) 0 Name of Sexton or Person in Charge of Premises rss'�(i_ Ceh�4 (please print) Ili Signature , Title steno' (over) DOH-1555 (02/2004)