Colvin, Rosemary # z �v
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
wine First Middle Last Sex
Rosemary Colvin Female
Date of Death Age If Veteran of U.S.Armed Forces,
03103/2022 73 Years War or Dates
Place of Death Hospital,Institution or
Z City,-[own or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death 0 Natural Cause []Accident Homicide Suicide ❑LJndetennined ❑Fending
Circumstances Investigation
W Medical Certifier Name title
0 Abigail Macomber PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 140
Burial Date Cemetery,Crematory or Facility Name
03/0712022 Pine View Crematonum
nEntombment Address
II]Creiriation Queenury Town,New York
Donation q71
6 nRenwval Date Place Removed
and/or and/or Held
Hold Address
0
iL Date Point o1
CO Transportation
by Common Shipment
Carrier Destination
Dale Cemetery Address
ri Disinterment
Date Cemetery Address
Reintennent
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.Q.Box 67,Hudson Falls,New York 12839
Name of Funeral Firnr Making Disposition or to Whom
Remains are Shipped,It Other than Above
5 Address
CC
W
a.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/04/2022 Registrar of Vital Statistics .Argrn:ioGn(Z-kittmicall; �f
(sgrralur el
District Number 5601 Place City Of Glens Falls
I certify that the remains 01 the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 3 it f ZL Place of Disposition nv.._
2 acliressl
till
CC (se<Irur{ (lot uurr erl (grimy nurnbe l
�
g Name of Sexton or Person in Charge of Pramjs
r� 41,
Z (pled a pr;irt;
Signature Title
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#