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Daly, Gertrude Mary it Mitt NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gertrude Mary Daly Female Date of Death Age If Veteran of U.S.Armed Forces, 12/04/2021 88 Years War or Dates 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 Homicide El SuicideUndetermined ❑Pending U Circumstances Investigation Ui Medical Certifier Name Title Matthew Loftus PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 574 ❑Burial Date Cemetery,Crematory or Facility Name 12/07/2021 Pine View Crematorium Entombment Address X❑Cremation Queensbury Town, New York ElDonation Z Date Place Removed Removal and/or Held rz and/or Hold Address 0 0- Date Point of N ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 I1J a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/06/2021 Registrar of Vital Statistics RpbertAncfrew Curtis(Electronicaffy 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: W Date of Disposition jt 1 1/1 Place of Disposition f (r4�r;� 2 (address) W CC (section) (tot number) (grave number) gName of Sexton or Person in Char a of Premises ` t• --� 'N Z (pse print) tL Signature Title CPA � DOH-1555{07/18)p 1 of 2 0 I L i 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#