Quarters, Edwin Allen It 251
A
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Edwin Allen Quarters Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/20/2022 65 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Schenectady Street Address Schenectady Center for Rehabilitation and Nursing
pManner of Death El Natural Cause Accident Homicide Suicide nUndetermined Pending
W Circumstances Investigation
WMedical Certifier Name Title
G Megan Putnam NP
Address
526 Altamont Ave,Schenectady,New York 12303
Death Certificate Filed City Of Schenectady District Number Register Number
City,Town or Village 4601 256
H
Burial Date Cemetery,Crematory or Facility Name
03/22/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
F— Hold Address
N
0
O. Date Point of
CO ETransportation Shipment
p by Common
Carrier Destination
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
H Remains are Shipped,If Other than Above
2 Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/22/2022 Registrar of Vital Statistics Samanta X!tykco(ECectronicalyy Signed)
(signature)
District Number 4601 Place City Of Schenectady
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i-
W Date of Disposition 3172 f 71 Place of Disposition "�/a dress/
W
CC (section) :°'::
LL /grave number/
QQ Name of Sexton or Person in Charge of Premise �( ` lIp int)
W z
i( 2Title i nflit-
Signature
DOH-1555(o7/18)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#