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Orsini, Annette Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Annette Elizabeth Orsini Female Date of Death Age If Veteran of U.S.Armed Forces, 02/10/2021 61 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing p Manner of Death © Natural Cause ❑Accident 12 Homicide 0 Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title C1 Leonard Gelman MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 19 ❑Burial Date Cemetery,Crematory or Facility Name 02/12/2021 Pine View Crematorium ❑Entombment Address lCremation Queensbury Town,New York Donation g Removal Date Place Removed and/or and/or Held N Hold Address 0 d Date Point of () 11 Transportation Elby'Orly°n Shipment Caririer Destination Date Cemetery Address ❑Disinterment Date Cemetery Address Reinterment 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 F Remains are Shipped,If Other than Above E Address C W • Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/12/2021 Registrar of Vital Statistics jenny Linda M MarteCCe(ECectronica1Cy Signed) (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: OAWDate of Disposition Z IIZ I 7( Place of Disposition , 2 (address) W CC CC (section/ (4'nWnber) (grave number) /I 0 Name of Sexton or Person in Chargea mises t r,r}-pc J(1 (pleaseint)rriot/ tL Signature Title rff4411f106C DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt 014538 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit I Official Funeral Directors Reg.or License# ! ;