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laBarron, Michelle Ann 19 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vitat Records Name First Middle Last Sex Michelle Ann LeBarron Female Date of Death Age If Veteran of U.S.Armed Forces, 02/06/2022 52 Years War or Dates F_ Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address 325 Broadway Apt.42, Fort Edward Town, New York 12828 1p Manner of Death Natural Cause ❑Accident ❑Homicide El Suicide El Undetermined ©Pending U Circumstances Investigation WI Medical Certifier Name Title Robert Lemieux Coroner Address 415 Lower Main Street, Hudson Falls Village, New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 12 Burial Date Cemetery,Crematory or Facility Name 02/16/2022 Pine View Crematorium Ei Entombment Address X❑Cremation Queensbury Town,New York El Donation nRemoval Date Place Removed and/or and/or Held ~ Hold Address 0 a. Date Point of Cl) Li Transportation p by Common Shipment 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 1— Remains are Shipped,If Other than Above Address Ce W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/09/2022 Registrar of Vital Statistics Aimee L 94ahoney(Electronically 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: l— Z Date of Disposition it r)1�z Place of Disposition ��t�l�•.•, � C3Y wi 2 (address) W Et N (section) (lot number) (grave number) Name of Sexton or Person in Charge of Prem es r Si144 Z (pleas print) W Signature Title �(rF�M � DOH-1555(07/18)p 1 of 2 r ; 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#