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Hamblin, Deborah NEW YORK STATE DEPARTMENT OF HEALTH f Burial - Transit Pelr�nit if 4 Vital Records Section Name First Middle Last Sex Deborah Lynn • Hamblin Female Date of Death Age If Veteran of U.S. Armed Forces, August 4, 2018 67 War or Dates ZPlace of Death Hospital, Institution or W City, Town or Village Fort Edward Street Address 1079 Burgoyne Ave Lot 4 CI Manner of Death 1771 Natural Cause 0 Accident ED Homicide 0 Suicide 0 Undetermined El Pending ILLJ 0 Circumstances Investigation W Medical Certifier Name Title in Joseph Foote MD, Address Rt 4 Hudson Falls, NY 12839 Death Certificate Filed District Number Register Nymber City, Town or Village 5�55 Li ❑Burial Date Cemetery or Crematory August 7, 2018 Pine View Crematorium Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z Removal and/or Held q Li and/or Address Hold 6 Date Point of a0 Transportation Shipment U) by Common Destination d Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address 1 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 MAddress W O. Permission is hereby granted to dispose of the human r ins described a ve indicated. Date Issued t— (p a)'$Registrar of Vital Statistics 6-01(, Y• (signature) District Number 55155 Place V -{-t.€ udu c1ld —, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 08/07/2018 Place of Disposition Quaker Road Queensbury,NY 12804 2 (address) W ce„ (section) tit number) (grave number) p " ^Name of Sexton or Person in Charge of Premises t�" �t r i LM.r f"{ (plea print) ill Signature �� Title Av6414 PA. (over) DOH-1555 (02/2004)