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Cary, Kathleen Belle NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathleen Belle Cary Female Date of Death Age If Veteran of U.S.Armed Forces, 12/24/2021 91 Years War or Dates Place of Death Hospital,Institution or Z Clty,T own or Village Scotia Village Street Address Baptist Health Nursing And Rehabilitation Center,Inc • Marite+of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation G Mei1ical Cr tifier�_ Name Title Lorraine Nimako NP Address 297 N Ballston Ave,Scotia Village,New York 12302 Death Certificate Filed District Number Register Number City,Town or Village Scotia Village 4620 088 ❑Burial Date Cemetery,Crematory or Facility Name 01/03/2022 Pine View Crematorium Entombment Address ElCremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held H Hold Address O - - EL Date Point of (I) 1-1 Transportation Shipment p by Common Carrier Destination El 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 I.. Remains are Shipped,If Other than Above 2 Address Er W ▪ Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/28/2021 Registrar of Vital Statistics Maria Ann Schmitz(E(ectronica((y Signed) (signature) District Number 4620 Place Scotia Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition s 127 Place of Disposition /adddddress) W NCC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises t 114 J C '`^41-t Z /p ase print/ /� LU Signature Title (� Ai iipz DOH-1555(07/18)p 1 of 2 r,, y,.. Public Health Law Sec. 4145(2b) 1.)2 Receipt 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#