Guay, Natalie Carol NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Natalie Carol Guay Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/01/2022 63 Years War or Dates
1_ Place of Death Hospital,Institution or
ZCity,Town or Village Hudson Falls Village Street Address 14 Coleman Avenue,Hudson Falls Village,New York 12839
`p Manner of Death i Natural Cause Accident Homicide Suicide Undetermined 17 Pending
V Circumstances Investigation
W Medical Certifier Name Title
C1 Robert Reeves MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Village Of Hudson Falls District Number Register Number
Cit ,Town or Village 5726 111
Burial Date Cemetery,Crematory or Facility Name
03/04/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
QRemoval Date Place Removed
and/or and/or Held
H Hold Address
N
0
11 Date Point of
U)ETransportation
p by Common Shipment
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
1— Remains are Shipped,If Other than Above
2 Address
IIr
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/04/2022 Registrar of Vital Statistics Cynthia Bardmn(ECectronica1Ty Signed)
(signature)
District Number 5726 Place Village Of Hudson Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
WDate of Disposition 3_5- Place of Disposition -p4r.4P it c e r e N u) -,.4„,j v ,�f
2 (address)
_J
IW
CC (section) (lot num e� (grave number)
SName of Sexton or Person in Charge of remiss �A�!'�IIJ� 'V`
z (please print/
W Signature <<cy� f Title C��lw��
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#