Barletta, Carolynne • # 31S
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Carolynne Barletta Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/28/2021 69 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Wilton Town Street Address 49 Cobble Hill Drive,Wilton Town,New York 12831
p Manner of Death ❑X Natural Cause ❑Accident Ei Homicide Suicide 11 Undetermined Pending
tL Circumstances Investigation
W Medical Certifier Name Title
CI Christine Roe NP
Address
3 Crossing Boulevard,Clifton Park Town,New York 12065
Death Certificate Filed District Number Register Number
City,Town or Village Gansevoort 4569 16
❑Burial Date Cemetery,Crematory or Facility Name
03/31/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
El Donation
Z Removal Date Place Removed
and/or and/or Held
N Hold Address
0
a Date Point of
f/) LI Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
Date Cemetery Address
❑Reinterment
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
Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/30/2021 Registrar of Vital Statistics Susan Baldwin gYctronicaf Sinned
(signature)
District Number 4569 Place Gansevoort, 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 ,3131 /7i Place of Disposition ,v,J. C�
W
2 (address)
W
CC (section) (lot number) (grave number)
CC ` 1
gName of Sexton or Person in Charge of Pr ises G' r'` `' "'�
Z (plea print/ /' n�
lL Signature Title C e `Oft
DOH-1555(07/18)p i of 2
l
Public Health Law Sec. 4145(2b) 1) 14 6 8 3
Receipt
e=:
Human remains of delivered on , 20
y ..,.F
Pine View Cemetery Representing the funeral home named nnbyi l.p7rmit
Official Funeral Directors Reg.or License# � 1 %,