Perkins, Deborah Carol # 3z/
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Deborah Carol Perkins Female
Date of Death Age It Veteran of U.S.Armed Forces,
04/15/2022 67 Years War or Dates
Place of Death Hospital,Institution or
Z City,town or Village Kingsbury Town Street Address 39 Rock City Road,Kingsbury Town,New York 12839
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0 Mannerof Death Ei Natural Cause ❑Accident Homicide 0Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
U
Ui Medical Certifier Name title
0 Darci Gaiotti-Grubbs MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Town Of Kingsbury District Number Register Number
City,town or Village 5762 7
ElBurial Date Cemetery,Crematory or Facility Name
04/18/2022 Pine View Crematory
nEntonibment Address
111Crernation Queensbury Town,New York
Donation
O❑Rerrroval Date Place Removed
and/or and/or Held
H Hold Address
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0
n- Date Point of
N n1 ransportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
7Disintennent
n Date Cemetery Address
I 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
1— Remains are Shipped,It Other than Above
,2 Address
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a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/18/2022 Registrar of Vital Statistics Cynthu;1Banisrr!'Thartmicuilj,50849
(S.r;,a1ure!
District Number 5762 Place Town Ot Kingsbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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Z Date of Disposition -1I1q IZZ. Place of Disposition
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(se.Ihm1 /f (lotnea,ber! (gtarrniorth&
Name of Sexton or Person in Charge of Premises - ^
(prse print!
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Signature Title i�C
DOH-1555(07/18)plot 2
1l 597
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#