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Cauffiel, Sharon Louise # 435 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sharon Louise Cauffiel Female Date of Death Age If Veteran of U.S.Armed Forces, 05/17/2021 64 Years War or Dates �.. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 32 Madison Street,Glens Falls,New York 12801 p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Anthony Petracca MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 220 Burial Date Cemetery,Crematory or Facility Name 05/20/2021 Pine View Crematorium 0 Entombment Address X❑Cremation Queensbury Town,New York ❑Donation ZO 1-1 RemovalDate Place Removed and/or and/or Held H Hold Address 0 CL Date Point of U) ❑Transportation Shipment by Common Carrier Destination 0 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 O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/19/2021 Registrar of Vital Statistics Robert Andrew Curtis(ECectronica1Ty Signed) (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: IF- WDate of Disposition .S 17i Ili Place of Disposition 2 (a ress) W CC N (section) (l /number) (grave number) 0 /j n✓ LiwV Name of Sexton or Person in Charge of remises Z (please pri ) liJ Signature Title '"" DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 01 z- 0 6 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#