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Collins, Cynthia Lynn drKb NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Cynthia Lynn Collins Female Date of Death Age If Veteran of U.S.Armed Forces, 01/06/2022 64 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Ili Manner of Death ©Natural Cause El Accident I:I Homicide ElSuicide 0 Undetermined El Pending W Circumstances Investigation U W Medical Certifier Name Title O Howard Silverberg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 29 0 Burial D Cemetery,Crematory or Facility Name 01 22 Pine View Crematorium Li EntombmentAdd s O Cremation Queensbury Town,New York ❑Donation g— El Removal Date Place Removed and/or and/or Held H Hold Address N d Date Point of Cl) Li Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address 0 Reinterment 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 H Remains are Shipped,If Other than Above 5 Address CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/12/2022 Registrar of Vital Statistics Megan.No[in(ECectronica1TySigned) (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: H _ Date of Disposition I I/5 li z Place of Disposition ?,,,11._ ZA—v,--, t11 address/ W NCC (section) g(lot number) (grave number) gName of Sexton or Person in Charge of Premis h` L.- s A Ai a- Z (plee print) IliEi _ 11( ►►�41I� Signature Title DOH-1555(07/18)p 1 of 2 07.55 8 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#