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Freebern, Jean Marie NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jean Marie Freebern Female Date of Death Age If Veteran of U.S.Armed Forces, 08/24/2021 77 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital p Manner of Death © Natural Cause ❑Accident ❑Homicide 0 Suicide D Undetermined ❑Pending LLJ Circumstances Investigation W Medical Certifier Name Title CI Rhiannon Kelsh-lasher MD Address 43 New Scotland Ave,Albany, New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2103 Burial Date Cemetery,Crematory or Facility Name 08/31/2021 Pine View Crematorium 0 Entombment Address Cremation Queensbury Town,New York 0 Donation ZZ Removal Date Place Removed and/or and/or Held N Hold Address 0 d Date Point of U) ❑Transportation by Common Shipment Carrier Destination 0 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 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/26/2021 Registrar of Vital Statistics Danielle S Gircespie(EYectronicaffy Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /11?"--- W Date of Disposition h IZi Place of Disposition (address) LU N CC (section) (lot number) (grave number) 2 Name of Sexton or Person in Charge Premises !^�' '4 11 Z (p ase print) p^�,, LU `Signature � "` Title t� rvi4104 DOH-1555(07/18)p 1 of 2 • 5 0q Public Health Law Sec. 4145(2b) Receipt Human remains of ^' delivered on ' , 20 7 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ff