Wells, Rachel Rae NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Rachel Rae Wells Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/034022 20 Years War or Dates
Pl eeof Death Hospital,Institution or
W "City,Town or Village Argyle Town Street Address State 197 Route,Argyle Town,New York 12809
p Manner of Death �NaturalCause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
C3 Robert Lemieux Coroner
Address
415 Lower Mai!Street,Hudson Falls Village,New York 12839
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town,rage 5750 7
Burial .° Date Cemetery,Crematory or Facility Name
03/14/2022 Pine View Crematorium
Entombment Address
;a
Cremation Queensbury Town,New York
Donation
a
g Removal Date Place Removed 40
•
and/or and/or Held
H Hold Address
N
0
O. Date Point of
N ETransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
ElReinterment 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
IH Remains are Shipped,If Other than Above
2 Address
CC
W
0' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/09/2022 Registrar of Vital Statistics Shelley Mfckonon(cElectronica/TySigned)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
WDate of Disposition 31 IS(72 Place of Disposition F44 V-
2 (address)
W
CO (section) /'I (tot number) (grave number)
8 Name of Sexton or Person in Charge of Pre ' sL r`r°4 Sr.I ft, (p ase print)
z
tU Si nature �� Title C�''►��hlkTo .
g
DOH-1555(07/18)p 1 of 2
i
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#