Putman, Christina •
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Christina Putnam Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/21/2021 69 Years War or Dates 1971-1975
Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death Natural Cause Accident D Homicide Suicide Undetermined ❑Pending
CUJ
.) Circumstances Investigation
W Medical Certifier Name Title
0 Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 353
ElBurial Date Cemetery,Crematory or Facility Name
08/23/2021 Pine View Crematorium
❑Entombment Address
Cremation Hudson Falls Village,New York
ElDonation
6 ❑Removal Date Place Removed
and/or and/or Held
- Hold Address
0
a Date Point of
Cl) �Transportation
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
Remains are Shipped,If Other than Above
2 Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/23/2021 Registrar of Vital Statistics 1lgbertAndrew Curtis(E(ectronica1Cy Signed)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
� ^ �1
Date of Disposition )- 7—)-1 Place of Disposition p ;�� Vtti Ci c.,,v 1 Gc>'
2 (address)
W
CCCC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises
0 ��-I r+cy sce,,,,r`.s
Z
(please print)
W Signature Title G rt,r''f-9/C r
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#