Thaxton, Nicole Marie it 213
NEW YORK STATE DEPARTMENT OF HEALTH " Burial - Transit Permit
Bureau of Vital Records
Name First Middle List Sex
Nicole Mane Thaxton Female
Date of Death Age It Veteran of U.S.Armed Forces,
03/10/2022 34 Years War or Dates
Place of Death Hospital,Institution or
Z City,?own or Village Saratoga Springs Street Address 27-0S I-87 interstate Highway.Saratoga Springs.New York 12885
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iQ Manner of Death []Natural Cause []Accident []Homicide []Suicide nUudetermined I�IPertdirtg
U ' I I (Circumstances II '(Investigation
Q Medical Certifier Name Title
David DeCelle Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed City Saratoga Springs District Number Register Number
City,down or Village 4501 169
Burial Date Cemetery,Crematory or Facility Name
03/17/2022 Pine View Crematorium
[]Entombment Address
[]Cremation Queensbury Town,New York
Donation
[]Removal Date Place Removed
andjor and/or Held
Hold Address
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0
fy Date Point of
✓)[]Transportation
Ej by Common Shipment
Carrier Destination
Date Cemetery Address
7Disinterment
Date Cemetery Address
[]Reinterntent
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
Remains are Shipped,It Other than Above
5 Address
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• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/15/2022 Registrar of Vital Statistics Dam Yoninr`Elcc7rimican;SJrrert
Esq n<?lur eI
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iiZJ Date of Disposition 5111 lit Place of Disposition
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SQ (se:lhrnJ I:rinurrrbe `�VMw�f �S: err vvurnLer/
Name of Sexton or Person iii Charge of Pren ses L lr
,Z (pk'ase rinll �p
W Signature Title aitU"
DOH-1555 lo7/18;i p 1 of 2
015 92
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#