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Ingleston, Gail Marie le9P( NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gail Marie Ingleston Female Date of Death Age If Veteran of U.S.Armed Forces, 11/26/2021 73 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Fort Edward Town Street Address 1079 Burgoyne Avenue Lot 1,Fort Edward Town,New York 12828 0 Manner of Death ©Natural Cause Accident EI Homicide ❑Suicide ❑Undetermined n Pending W Circumstances Investigation W Medical Certifier Name Title G Rita All NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 68 ❑Burial Date Cemetery,Crematory or Facility Name 11/30/2021 Pine View Crematorium ❑Entombment Address lCremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held F- Hold Address N 0 O. Date Point of N ❑Transportation Shipment p by Common 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 F Remains are Shipped,If Other than Above 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/30/2021 Registrar of Vital Statistics Aimee£Mahoney(ECectronicalty Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH W Date of Disposition ja—/'ZO Z/ Place of Disposition el/0e �V 44.) (address) W N CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Char of Premi s K-A Mviv ci 1100 (please print) W Signature ---1-2g7 Title c%'w (r DOH-1555(07/18)p 1 of 2 Ck' 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#