Pratt, Estella M NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Estella Maude Pratt female
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Date of Death Age If Veteran of U.S.Armed Forces,
Jan 17 19 91 8 0 War or Dates 0
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Z Place of Death Hospital Institution or
L#.t, 5, x jpk\�I4pagc of Queensbur Street Address 17 Quarry Crossing
Town I Y. ..............
Q Manner of Death..... ..::: . ..:.. .... : Undetermined Pending
❑ Natural Cause ❑ Accident ❑ Homicide ❑ SuicideEi
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Circumstances Investigation
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Medical Certifier Name Title
G! Daniel Larson , MD
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Address
P . O . Box 666, Glens Falls , NY
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Death Certificate Filed District Number Register Number
PjWxTownRrXV&§jqX Queensbury 5657
Date Cemetery or Crematory
❑Burial January 18 , 1991 Pine View Crematorium
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Cremation
Address ......... ,:.
Town of Queensbury , New York
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Z Date Place Removed
O ❑ Removal and/or Held
H and/or Hold Addres-e-s-:s: . ........
N
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IL Date Point of
cn; []Transportation by Shipment
pCommon Carrier ........................ ......... ........: . . .......................................
Destination
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❑ Disinterment Date Cemetery Address
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❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm Carleton Funeral Home Inc . 00310
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Address
P . O . Box 67 , 68 Main St . , Hudson Falls , NY 12839
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1--:; Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
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Address
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Permission is hereby granted to dispose of the hu remains described s indicate
Date Issued �" "1 9 t Registrar of Vital Statistics
�-- nature)
District Number 5657 Place
I certify that the remains of the decedent identified above we disp sed of in accordance w' this perm on:
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Z Date of Disposition Z �� 9/ Place of Disposition
2 (address)
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Cn (section) (lot number) (grave number)
X
p Name of Sexton Person in arge of Premises �,�L.
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Z lease print)
W Signature Title C�11.�/ei��d/( 4JJ//
DOH-1555 (10/89) p. 1 of 2 VS-61