Goodman, Linda Marie Jje (11Z
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Linda Marie Goodman Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/11/2021 65 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Hudson Falls Village Street Address 15 Jones Avenue, Hudson Falls Village,New York 12839
`p Manner of Death Natural Cause ID Accident Homicide D Suicide Undetermined Ei Pending
1.1
U Circumstances Investigation
W Medical Certifier Name Title
Q
Aqeel Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Hudson Falls Village 5726 17
Burial Date Cemetery,Crematory or Facility Name
06/15/2021 Pine View Crematorium
0 Entombment Address
0 Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
0
1-1 Date Point of
Cl) ❑Transportation
p by 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 06/14/2021 Registrar of Vital Statistics CynthiaA Bardin(Efectronica(CySigned)
(signature)
District Number 5726 Place Hudson Falls Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�
W Date of Disposition �ijlbf'4 Place of Disposition _' fet L cafi40-.—
2 (address)
W
CC (section) lot number (grave number)
Name of Sexton or Person in Charge of Premis C !c �pl- sH '
Z (Ass print) /�LU Signature Title ` [ (Z
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b) 0.14859
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#