Durling, Jeanne NEW YORK STATE DEPARTMENT OF HEALTH /
Vital Records Section Burial - Traasii ermit
Name First Middle Last Sex
Jeanne Anne Durling Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 10, 2013 87 War or Dates
Place of Death Hospital, Institution or
w City, Town or Village Queensbury Street Address The Stanton Nursing & Rehab. Center
W Manner of Death a Natural Cause n Accident ❑ Homicide n Suicide ❑ Undetermined n Pending
Circumstances Investigation
0
W Medical Certifier Name Title
0 Bernardo R Villajuan MD,
Address
161 Carey Road Queensbury, NY 12804
Dew Certificate FiledC Dist Number Register Number
City, Town_)Village U\Q1/4 Qv`� ( I -*I_-j
❑Burial
Date Cemetery or Crematory
December 12, 2013
['Entombment Address
Cremation
Date Place Removed
z ❑ Removal and/or Held
a and/or Address
E_. Hold Pine View Crematorium
CO Date Point of
dn Transportation Shipment
U) by Common Destination
] Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
El 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
I— Remains are Shipped, If Other than Above
2' Address
W
O. Permission is hereby granted to dispose of the human r ins described abo g as indicated.
Date Issued `�-) ) ,...I �3Registrar of Vital Statistics G, Q , r
(signature)
District Numbe o --) Place )) « ^ 0 4 Cc I .0—r-vC1
F= I certify that the remains of the decedent identified above were disposed of in accordan with his permit on:
W, Date of Disposition (z-R.-1( Place of Disposition •t', u,...) Ciw—fior'i-.-
E (address)
W'
':
i (section) lot pumber) (grave number)
0, Name of Sexton or Person in Charge of Premises air..A Sco,-,171-
Z (please print)
W, Signature4 Title Ce(i6
(over)
DOH-1555 (02/2004)