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Legualt, Myrna Madeline atio� NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Myrna Madeline Legault Female Date of Death Age If Veteran of U.S.Armed Forces, 05/07/2021 83 Years War or Dates �., Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital W Manner of Death © W Natural Cause Accident 1=1 Homicide 1=1 Suicide Undetermined Ei Pending U Circumstances Investigation Q Medical Certifier Name Title Laura Lambiase PA Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 1209 ❑Burial Date Cemetery,Crematory or Facility Name 05/10/2021 Pine View Crematorium ❑Entombment Address Cremation Queensbury Town,New York ElDonation ORemoval Date Place Removed and/or and/or Held - Hold Address 0 Date Point of U) Li Transportation El Common Shipment Carrier Destination Disinterment Date Cemetery Address 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 F- 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 05/10/2021 Registrar of Vital Statistics cDanie(Ce S CiCCespie(ECectronicatTy Signer) (signature) District Number 0101 Place Albany, 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 S/I,I it Place of Disposition 2 (ad ress) W' CC (section) / (tot number) (grave number) 2 Name of Sexton or Person in Charge of Premi G (I+ t-- ��+�►w Ati Z (pleasepirint) LV Signature Title C r(70tii01C DOH-1555(07/18)p i of 2 A � r` Public Health Law Sec. 4145(2b) 1 0 1 4 7 �4 , Receipt I ( y ,; Human remains of k � �� n delivered on � 20 f i Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#