Allen Jenny Anne NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jenny Anne Allen Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/15/2021 54 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls,New York
W Undetermined Pending
W Manner of Death Natural Cause �Accident �Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
C3 William Parker MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 253
❑Burial Date Cemetery,Crematory or Facility Name
06/18/2021 Pine View Crematorium
❑Entombment Address
lCremation Queensbury Town,New York
❑Donation
ZO ❑Removal Date Place Removed
and/or and/or Held
N Hold Address
O
G. Date Point of
V) 1-1
Transportation
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
Remains are Shipped,If Other than Above
5 Address
CC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/18/2021 Registrar of Vital Statistics 1p6ertAndrew Curtis(ECectronica1TySigned)
(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:
Date of Disposition 4-19-R02/ Place of Disposition �; 'e et-efl1 en
enijk
/addr
W
Q (section) f //atnumber/ i (grave number)
Name of Sexton or Person in Charg Premises � O�'�I �a�
Z ` / !/ (please print/
W Signature 4 / �N Title D e
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 1 4
1 Receipt
1
Human remains of delivered on , 20
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#