Loading...
Ford, Debra L Z3cO • NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Debra L Ford Female Date of Death Age It Veteran of U.S.Armed Forces, 03108/2022 63 Years War or Dates 1_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital Mannerol Death I I Natural Cause nAccident Homicide nSuicide ❑Llrtdeterrrtined nPemfing I I Circrunstances II I(Investigation V Title tl! Medical Certifier Name © Mathew Varughese DO 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 156 • Burial Date Cemetery,Crematory or Facility Name 03/11'2022 Pine View Crematorium nhntumbrnent Address nCrernation Oueensbury Town,New York Donation Z Date Place Removed O Rem oval and;'or and/or Held F.) Hold Address 0 ELn Date Point ot Cl)I I=ransportation Shipment by Comrnun Carrier Destination Date Cemetery Address Disinterment nDate Cemetery Address I Reinterment 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,It Other than Above 5 Address CC itfl a Permission is hereby granted to dispose of the human remains described above as indicated. Dale Issued 03/11/2022 Registrar of Vital Statistics tfivun`1`oFia,r kt-ronrr S fuf (.5 gnalur e/ District Number 5601 Place City Of Glens Falls I certity that the remains ot the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition `2),—,02 Q©22'lace o1 Disposition J J,` e„�) g (ash ; w (s,i/on/ �{� (lot urnb rl ({eJYL nurnbar: SNarr€e of Sexton or Person in Char of Premise ��"'(AQ/`r`N grad Z / p&>use pr/ell CLJ Signature / Title �kTa 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#