Gamache, Dorothy NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section . Burial - Transit Permit
Name First I Middle Last Sex
Dorothy May Gamache Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/15/2018 84 Years War or Dates
Place of Death H Institution or
City, Town or Village Queensbury Town . i1xet Address The Stanton Nursing And Rehabilitation Centre
Manner of Death®Natural Cause ❑Accident fl Homicide El Suicide El Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Kenneth France MD
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657 112
El Burial Date Cemetery or Crematory
08/21/2018 Pine View Crematorium
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
0 Transportation Shipment
by Common Destination
Carrier
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 Stpo Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/17/2018 Registrar of Vital Statistics Caroline J(Bar6er(ECectronica1TySigned)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition $ Place of Disposition P; V C.k 'Y
(address)
(section) (tot number) (grave number)
Name of Sexton or Person in Charge of Premises le(?fltsY JjMt(1 S
(please print)
Signature Title L rz4111/J'
(over)
DOH-1555 (02/2004)