Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Wheeler, Crystal A
NEW YORKSTATE DEPARTMENT OF Bureau of Vital Records HEALTH Name First e.70 �A Wheeler �,;�� Burial - Transit Permit Date of Death 10/12/2021 ' Last 36 Years If Veteran of U$firmed Forces, f- pace of Death War or Crty,Town or Village Dates V1G Mannerof Death Hudson Falls Village �spital,Institution or ©Natural Cause Street Address �W Medical Certifier ❑AccidentCl 42 Suicide Willow Street, Homicide Hudson Falls Village New Yo Name Suicide 0Undetermined 12839 Noelle Stevens Pending too Broad Street, Title Circumstances Address Investigation Death Certificate Filed Glens Falls,New York 12801 MD City,Town or Village Hudson Falls Village District Number ❑Burial Date 5726 Entombment10/22/2021 Cemetery,CrematoryRegister Number Pine View Cremator: °r Facility Name 28 CI Cremation Address mator: anon Queensbury 0 Donation Town,New York 0❑Removal Date Eand/or Place Removed D Hold Address and/or Held Z A ['Transportation Date Point of by Common Shipment Carrier Destination Date I Dish Cemetery Address , Cemetery Address P Reiraerment Dad J Registration Number permit Issued to Carleton Funeral Home Inc 00281 lame of Funeral Home Address Box g7,Hudson Falls New York 12839 P.O. o to llhom 68 Main Street. Disposition Name of Fug Firm Making P F.. Remains are dipped,If Other than Aba� Adder ranted to disse of the human remains described above as indicated. IgS10n is hereby rtal Statistics Cynthia fit Zarein(�ECectronicaQv Signed) eP�}strar✓ (signature) Date I Date ssued tas�t place dson Falls Village, New York District Number above were disposed of in accordance with this permit on: decedent den that the remains of ,f Disposition -VI` I certify I C i 13',L (address) ZDate of Disposition (grave number) Ill /section) (!d number) Ns / (pie, print) . ccon or Person in Charge°I/ / G �`f��` QName of Seat Tile Z W Signature .__i.QAn1of2 1 / 3. - - Public Health Law Sec. 4145(2b) Receipt 1 Human remains of delivered on , 20 1 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#