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Pratt, Majorie Louise a NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Marjorie Louise Pratt Female Date of Death Age If Veteran of U.S.Armed Forces, 07/24/2021 95 Years War or Dates F- Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 47 Garrison Road, Queensbury Town, New York 12804 p Manner of Death ©Natural Cause 0 Accident ❑Homicide Ei Suicide 0Undetermined ❑Pending tL C.) Circumstances Investigation CI Medical Certifier Name Title David Foote MD Address 340A Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 153 0 Burial Date Cemetery,Crematory or Facility Name 07/29/2021 Pine View Crematorium 0 Fntombment Address 0 Cremation Queensbury Town,New York ❑Donation ZZ Removal Date Place Removed F- and/or and/or Held N Hold Address 0 Cl) Transportation Date Point of 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 E- Remains are Shipped,If Other than Above S Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/26/2021 Registrar of Vital Statistics Caroline'fiC�Cegarde Barber(ECectronica1TySigned) (signature/ District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l— WDate of Disposition ) -.-1 Place of Disposition Pi)� LAGS C,fc.rt4 'y 2 (address) W Cl) O (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises -rtimtY 5fi.,;f�5 Z (please print) Ill Signature Title Gr(m;.}cr DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) .W 14 9 R 9 Receipt Human remains of ' delivered on , 20 Pine View Cemetery Representing the funeral home named on burial Permit Official Funeral Directors Reg.or License# -