Bowers, Carol NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carol Ann Bowers Female
Date of Death
1 1994 Age 47 If Veteran of U.S. Armed Forces,
y ' War or Dates
Place of Death Hospital, Institution or
-OdyxTown oRMittexKfngsbury Street Address 102 Burgoyne Ave.
Manner of Death ®Natural Cause Accident Homicide SuicideEl Undetermined Ei Pending
Circumstances Investigation
Medical Certifier Name Title
Vincent D. Koh tID
Address
428 Glen St., Glens Falls, NY 12801
<: Death Certificate Filed District Number Register Number
Vt�, Town 0 ViRw Kingsbury 5762
Date Cemetery or Crematory
❑Burial July 18, 1994 Fine View Crematorium
QX Address
Cremation Tn of Aueensbury, NY 12804
Date Place Removed
❑Removal -- Fand/or Held
and/or Address
Hold
Q Date Point of
a.
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Reg%6ig8 Number
Name of Funeral Home Carleton Funeral Home Inc.
Addrpsb. Box 67, 68 Main St., Hudson Falls, N.Y. 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
A.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued gL.PQ & y Registrar of Vital Statistics
(signatu )
District Number 5762 Place town of Kingsbury, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1`-
F Date of Disposition �9 Place of Disposition �N� 1.c�L) C jX 7e-fir al
(address)
Uj
(section (lot
t n mb (grave number)
Name of Sexton Person Charge of Premises
(please print)
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61