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Kerr, Alice Veronica Ir. 131 NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Alice Veronica Kerr Female Date of Death Age If Veteran of U.S.Armed Forces, 12/12/2020 80 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Hudson Falls Village Street Address 11 Sixth Street, Hudson Falls Village, New York 12839 p Manner of Death ©Natural Cause ❑Accident Homicide 0 Suicide El Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title O Lisa Greenwald NP Address 2 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 5726 40 ❑Burial Date Cemetery,Crematory or Facility Name 12/14/2020 Pine View Crematorium EiEntombment Address X❑Cremation Queensbury Town,New York ❑Donation OZ ❑Removal Date Place Removed and/or and/or Held H Hold Address O d Date Point of (I) 1-1 Transportation Li Common Shipment Carrier Destination 0 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 1.. Remains are Shipped,If Other than Above g Address CC LU a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/14/2020 Registrar of Vital Statistics Cynthia Bardin(ECectronica1Ty Signed) (signature) District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition iZ'I S'ZD Place of Disposition 2 (address) W CC CC (section) llq lnuFber/ (grave number) 11 0 Name of Sexton or Person in Charge •of Prem. !i/�I, n'� (please pr t/ �j LUSignature Title 'I vr DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) c 4 1. Receipt Human remains of delivered on , 20_ s Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#