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Lanza, Daniella Joyce rt NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Danielle Joyce Lanza Female Date of Death Age If Veteran of U.S.Armed Forces, 08/24/2021 60 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Ausable Town Street Address 70 Ausable Street,Ausable Town, New York 12944 p Manner of Death ❑ Natural Cause Accident Homicide Suicide ❑Undetermined ©Pending (Wj Circumstances Investigation CI Medical Certifier Name Title Chad Deans Coroner Address 137 Margaret Street Ste 208,Plattsburgh,New York 12901 Death Certificate Filed District Number Register Number City,Town or Village Keeseville 0951 11 Burial Date Cemetery,Crematory or Facility Name 09/01/2021 Pine View Crematorium ❑Entombment Address iCremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held H Hold Address 0 Date Point of N Li 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 WhomI— Remains are Shipped,If Other than Above Address a W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/27/2021 Registrar of Vital Statistics Bonnie G.7fopkz'ns(E(ectronicaCCy Signed) (signature) District Number 0951 Place Keeseville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition w 13114 Place of Disposition 2 (address) W N CC (section) p(lot number/ �1 (grave number) Name of Sexton or Person in Charge of Premi s Z pl se print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#