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Speowski, Frances Genevieve \t t1 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Frances Genevieve Speowski Female Date of Death Age If Veteran of U.S.Armed Forces, 12/30/2020 92 Years War or Dates F. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Manner of Death © Natural Cause 0 Accident El Homicide ❑Suicide ❑Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title p Jean Flanagan MD Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 606 0 Burial Date Cemetery,Crematory or Facility Name 12/31/2020 Pine View Crematorium 0 Entombment Address lCremation Queensbury Town,New York ❑Donation ZO Removal Date Place Removed and/or and/or Held F- Hold Address 0 d Date Point of Cl) Li Transportation Shipment p by Common Carrier Destination ElDisinterment Date Cemetery Address El 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 W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/31/2020 Registrar of Vital Statistics q?g6ertAnrfrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:Z Date of Disposition /2^3/-?.p 2ca Place of Disposition ?/)11 Q lr MI.() c'ma. //0 y W (address) W NCC (section) (lot number) (grave number) • Name of Sexton or Person in e of P mises 6 p jr IAbra�` ri--— (please print) w 1 L/Gkyle,.,�uty Signature Title / DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014360 Receipt Human remains of i delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#