Monahan, Karen Marie NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Karen Marie Monahan Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/10/2021 50 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Hudson Falls Village Street Address 12 Seventh Street,Hudson Falls Village,New York 12839
p Manner of Death Natural Cause ❑Accident ❑Homicide El Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Robert Lemieux Coroner
Address
415 Lower Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed District Number Register Number
City,Town or Village Hudson Falls Village 5726 18
❑Burial Date Cemetery,Crematory or Facility Name
06/16/2021 Pine View Crematorium
ElEntombment Address
0 Cremation Queensbury Town,New York
❑Donation
OZ ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
d 1-1 Date Point of
f/) u Transportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
ElDisinterment
❑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
1— Remains are Shipped,If Other than Above
g Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/16/2021 Registrar of Vital Statistics Cynthia ABartlin(ECectronicalTySigned)
(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:
Z 'L Place of Disposition "Fink / tOr<,"-
W Date of Disposition Cv (� P (address)
W
� (section) (lot number (grave number)
/r
gName of Sexton or Person in Charge of Premises
Z /
W �� (please print)
+ Title �►W��
Signature
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b) 0 I i S
Receipt
Human remains of rt r delivered on , 20
i
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#