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Flauto, Carmen Anna Marie NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carmen Anna Marie Flauto Female Date of Death Age If Veteran of U.S.Armed Forces, 02/02/2022 89 Years War or Dates i— Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 17 Centennial Drive,Queensbury Town,New York 12804 p Manner of Death ©Natural Cause ❑Accident 0 Homicide ❑Suicide Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title 0 Donald Merrihew MD Address 319 Bay Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 30 ©Burial Date Cemetery,Crematory or Facility Name 02/07/2022 Pine View Cemetery ElEntombment Address ElCremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed © and/or and/or Held I— ..-- Hold Address 0 ❑Transportation Date Point of 5 by Common Shipment Carrier Destination EIDisinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom I. Remains are Shipped,If Other than Above 3 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/07/2022 Registrar of Vital Statistics Caroline.7fifcregarrfe Barber(ECectronicalTySigned) (signature) District Number 5657 Place Queensbury, New York — I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 2. 7.2 0 2 2 Place of Disposition 21 Quaker Rd. Queensbury, NY 12804 in 2 (address) � Huron 20G 2 CC (sedan) (lot number) (grave number) g Name of Sexton r Person in Charge o Premises Connie Goedert (please print) W Signature E.- 4..P Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) U 1 2 8 9 9 Receipt Human remains of delivered on , 20 J- Pine View Cemetery Representing the funeral home named on burial permit /Official Funeral Directors Reg.or License# Flauto NAME Carmen Anna Marie Flauto Age: 89 Lot Owner: Frank & Carmen Flauto & Marie Buff Lot# Huron 20G Grave# 2 Case: Concrete Died: 2 .2.22. Interred: 2 .7 .2 2 Funeral Home: Regan Denny Stafford Cemetery: Pine View FLAUTO-BUFF a - rl LFLot No. * idress PO Box 2253 . Glens Falls , NY 12801 Section No. wner Frank , Carmen Flauto & Marie Buff Plot Huron ate 8/25/99 Approx . 100 Superficial ft. cation Bounded on North by Corentto & Burt , South by Butler , East by Burt , West by LeClair . )rner Posts marks NOTE : Grave #1-Frank-Grave #2-Carmen-Grave #3-Marie FLAura 192. 2.4SG, eed No. (and changes) 2982 iyment Record Paid in Full 8/25/99 ($1 , 050 . 00) !cord of Interments h_,v. 4 L :4�:a �� \ 'a I� u l R..41f_x1Ann r ij/ft) F15 r2'7'v2� o�•�r ? e Marie Buff 4/1/03 C r t q E y 1 r 4 VS T-7 w L 7 rm No. 01