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Vallone,Tammy M It sq NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Tammy M.Vallone Female Date of Death Age If Veteran of U.S.Armed Forces, 01/13/2022 55 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 0• Manner of Death ©Natural Cause ❑Accident ❑Homicide Ei Suicide El Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title CI Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 41 ❑Burial Date Cemetery,Crematory or Facility Name 01/18/2022 Pine View Crematorium ❑Entombment Address lCremation Queensbury Town,New York O Donation 4S ❑Removal Date Place Removed and/or and/or Held H Hold Address N 2 Date Point of to ❑Transportation Shipment CI 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 H Remains are Shipped,If Other than Above IAddress W CL' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/18/2022 Registrar of Vital Statistics Megan Wolin(ECectronicalTySigned) (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 perm m(itt on: Z �..1b1 (. ?ri.._.. 111 Date of Disposition I �2c�Z2 Place of Disposition 2 (address) W Ce (section) (IL (lotnumber) (gravenumber) gName of Sexton or Person in Charge of Pre ' -can Z (please print / `t<W E� Title ((?"0"til' Signature DOH-1555(07/18)p 1 of 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# °