Huston, Jean M. 5e
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jean M.Huston Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/14/2021 38 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
`p Manner of Death ❑X Natural Cause 0 Accident ElHomicide 0 Suicide ElUndetermined D Pending
V Circumstances Investigation
WD Medical Certifier Name Title
Marcille Labban MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 29
Burial Date Cemetery,Crematory or Facility Name
01/16/2021 Pine View Crematory
Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
ZO Removal Date Place Removed
El
and/or and/or Held
Hold Address
0
tl Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
11 Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/16/2021 Registrar of Vital Statistics R6ert, ttdew Curtis g ctronicali:ySrgned)
(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 /-//r—2 2 ( Place of Disposition 0 ,0 e t/:, C rejvj,t• f�1
2 (address)---)
W
N
CC (section) I (tot number) (grave number)
aName of Sexton or Person in Cha of Pre se /` `i /Y/Bry [' _ !0(90C1
Z 1 (please print)
W SignatureCS—;
j Title d�Pnvz7d
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) _
Receipt
{
Human remains of fir' delivered on ' , 20
Pine View Cemetery Representing the funeral home named on burial,permit
Official Funeral Directors Reg.or License# •