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Hesse, Unknown 06/1V2021 FRI 13: 10 FAX Q001/001 > sII NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit "' Name First Middle Last Sex Unknown Hesse Female Date of Death Age If Veteran of U.S. Armed Forces, 06/15/2021 0 years War or Dates '.. Place of Death Hospital, Institution or it City, Tom( Glens Falls , Street Address C;I pi)�Falls Hospital_ _ Manner of Death! Natural Cause El Accident El Homicide Suicide Undetermined r i Pending Circumstances Investigation Medical Certifier Name Title f4 Cassie Leonard flortor • N Address ligi 90 South Street Glens Falls, Ny 12801 ''```. Death Certificate Filed District Number Register Number , City. Tcxxxx• 1( Glens Falls 5601 4 =. . ❑Burial Date Cemetery or Crematory iV 06/19/202j Pineview C_rematory _.©Entombment Address "!] Cremation 0 . Queensbury, N Y 12804 ,,, Date Place Removed Removal and/or Held and/or Address _=' Hold ODate Point of Transportation _ Shipment _ by Common Destination Carrier • Aii L]Disinterment • Date Cemetery Address • >'x' ` ❑ Date Cemetery Address Renterment '"` Permit Issued to ' Registration Number 00263 ;it Name of Funeral Home Carleton Funeral Home, Inc. , ''i, Address Ki•" .„ 68 Main Street Hudson Falls, N Y 12801 - ;: Name of Funeral Firm Making Disposition or to Whom .-- Remains.are Shipped, If Other than Above •Address Permission is hereby granted to dispose of the human remains described above as indicated. _ Registrar of Vital Statistics • ':. Date Issued ' 06/18/2021 9 _ (signatur >` District Number '6Q,1 Place teens Falls . I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition W/z304 Place of Disposition 47: IL 40("0-- _ (address) (section) 2(lot number (grave number) IA A+ � Lwa14 Name of Sexton or Person in arge of Premise _ (Plea a print) k Signature- /-- • • Title . (17,0404. . . .. . • (over) DOH-1555 (02/2004) Public Health Law Sec. 4145(2b) 0 14379 Receipt Human remains of y'> delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#