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Moore, Landon Rose
NEW YORK STATE DEPARTMENT OF HEALTH it/L r Burial• Records Section - Transit Permit Name First Middle Last Sex Landon Rose Moore Female Date of Death Age If Veteran of U.S. Armed Forces, January 1, 2021 War or Dates ZPlace of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital 13 Manner of Death X❑ Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending fW' Circumstances Investigation W Medical Certifier Name Title JtsSIeA CIadz. Obray4 Address U/ /Oa R,rk Sr. Gieis 11k 4"Y /2 '1 Death Certificate Filed District Number Register Number City, Town or Village _.5 6 G i i ❑Burial Date Cemetery or Crematory January 5, 2021 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held • and/or Address F Hold Date Point of a. ❑Transportation Shipment (0- by Common Destination C') Carrier Date Cemetery Address El Disinterment ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom I—, Remains are Shipped, If Other than Above 2; Address CZ' WS Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued J/5 f zo --2_c.3Registrar of Vital Statistics LA) .1 (signature) District Number 5 6 0 i Place 6 LQA,_S f j�,1\ S 4 /l: Li I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 01/05/2021 Place of Disposition Quaker Road Queensbury,NY 12804 X (address) W CO (section) /'I(lot number) (grave number) a' Name of Sexton or Person i harge of Pre es l,r � !^^�ett Z (plelase print) /� W Signature Title c a` ttni C.� , Sg 1" (over) DOH-1555 (02/2004) 411111111■ Public Health Law Sec. 4145(2b) 014.6 0 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#