Dion, Joyce NEW YORK STATE DEPARTMENT OF HEALTH, # (P-1
Vital Records Section r Burial - Transit Permit
[lc Name First Middle Last Sex
Joyce Elsie Dion Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 10, 2013 80 War or Dates
I—` Plac-=f Death Hospital, Institution or
Li City, ' ow .r Village Kingsbury Street Address 3 Moss Street Square
Manner of Death Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Ilt
V Circumstances Investigation
LCt Medical Certifier Name Title
V James North, M.D
z ' Address
100 Broad St. Glens Falls, NY 12801
' Death icate Filed i_ N District Number Register Number
City, ow r Village i n GJ S b t Li 5-7La 1g
a❑Burial Date Cemetery or Crematory
November 13, 2013 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
'z❑ Removal and/or Held
and/or Address
f Hold
Date Point of
p' ❑Transportation Shipment
CO by Common Destination
0, Carrier
Date Cemetery Address
❑ Disinterment
❑ 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
'' Address
11,4
IV` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued &Ir. Jq, /3 Registrar of Vital Statistics , . 17),a_li—
(signature)
District Number 6-774 ,.. Place cam/ , ! ,41 , ))y—
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I Date of Disposition //-/ /3 Place of Disposition pot (,/ ( 1,�,-t/J,''e�
-' i, (address)
:LU
C
l�r (section) �( umb ) (grave number)
Name of Sexton Per n in e of Premises �� (TJ�lic� d
C (please p�r'''t)
W Signature Title -,l.��r�'� Ay(
(over)
DOH-1555 (02/2004)