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Cooper, Janet Louise
if- NEW YORK STATE DEPARTMENT '-- i //S�OFHEALTH Burlap - Transit Permit Bureau of Vital Records Name First Middle Last Sex Janet Louise Cooper Female Date of Death Age If Veteran of U.S.Armed Forces, 10/22/2020 76 Years War or Dates ZZ Place of Death Hospital,Institution or UJ City,Town or Village Fort Edward Town Street Address 1141 Burgoyne Avenue,Fort Edward Town,New York 12828 p Manner of Death ©Natural Cause Ei Accident 0 Homicide Suicide El Undetermined El Pending W U Circumstances Investigation Q Medical Certifier Name Title Charles Yun MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 91 ElBurial Date Cemetery,Crematory or Facility Name 10/23/2020 Pine View Crematoirum Ei Entombment Address lCremation Queensbury Town,New York EIDonation 0 0 Removal Date Place Removed H and/or and/or Held N Hold Address 0 d Date Point of co U Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 5 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/23/2020 Registrar of Vital Statistics Aimee.9lfafroney(ECectronicatry signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permi • r� 4........._ ~ V W Date of Disposition 10 f jy TO Place of Disposition �W ►� 2 (address) W N CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge Premises C., V /nh%iiti 'Z /plea print) Signature e _ Title a P'rvn DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014144 Receipt Human remains of delivered on , 20 I Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# r l